Male sex tied to better outcomes in early ACPA-negative rheumatoid arthritis

Men with anticitrullinated peptide antibody (ACPA)-negative early rheumatoid arthritis (RA) tend to have favourable clinical outcomes than their female counterparts, a study has shown. However, such benefit is not seen in those with ACPA-positive early RA.

“The poor outcomes in females with early seronegative RA suggest that this represents a difficult-to-treat patient group,” the investigators said.

This study examined two inception cohorts of consecutive patients with early RA (ie, symptom duration ≤12 months) in the southern region of Sweden. Participants were then stratified according to their ACPA status. The investigators also assessed the relationship between sex and clinical outcomes using logistic regression models, adjusted for age, Disease Activity Score in 28 joints (DAS28) values, and Health Assessment Questionnaire values at baseline.

Remission (DAS28 <2.6) at 12 months was the primary outcome, while remission at 6 months and European Alliance of Associations for Rheumatology good response at 6 and 12 months compared to baseline were secondary ones.

Of the 426 patients with early RA included, 160 were ACPA-negative and 266 were ACPA-positive. At 12 months, DAS28 remission was achieved by 27.1 percent (38/140) of females and 24.1 percent (13/54) of males with ACPA-positive RA. In those with ACPA-negative RA, 16.0 percent (13/81) of females and 48.6 percent (18/37) of males achieved DAS28 remission at 12 months.

Males in the ACPA-negative patient group were more likely to achieve remission at 12 months (pooled adjusted odds ratio [OR], 4.79, 95 percent confidence interval [CI], 1.97‒11.6), but not those in the ACPA-positive group (pooled adjusted OR, 1.06, 95 percent CI, 0.49‒2.30).