An improved understanding of sex and gender is crucial for precision rheumatology

Clinical Rheumatology -     

Age and gender difference in rheumatology

Most collagen diseases are more common in women except polyarteritis nodosa, but aging makes this gender difference smaller in some of the diseases. In systemic lupus erythematosus the incidence difference between men and women diminishes while Sjogren syndrome is more common in women at all ages. Diabetes mellitus and hyperlipidemia are also very common complications with steroid treatment. DM is more common in those aged over 45 years old. On the contrary, hyperlipidemia is common at all ages with the peak in those 45-54 years old and only 22% over 75 years old have hyperlipidemia. According to the introduction of aggressive therapy for rheumatoid arthritis, complications in the elderly should be carefully managed.     

Sex and gender issues and venous thromboembolism

At least 250,000 episodes of VTE leading to hospitalization or death are estimated to occur in the United States each year. A number of clinical and demographic risk factors for VTE are recognized,with the latter including both age and race. Overall,the incidence of VTE does not appear to vary significantly by sex, as evidenced by a lack of consistency in the magnitude and even direction of effect of sex in a variety of epidemiologic studies of varying design. Several studies have shown a higher incidence among women than men during childbearing age. The issue of a gender effect on the natural history of VTE has not been well studied. The main influence of gender on VTE is the relationship between female gender and several well-recognized clinical risk factors for VTE:oral contraceptive use, hormone replacement therapy, estrogen receptor modulator therapy, and pregnancy. Hormonal therapies are associated with a twofold to threefold increase in VTE incidence. Risk is higher with some formulations than others, during initial use, and among women who are obese, smoke, or have one of several forms of heritable thrombophilia. The pregnant state is associated with a threefold to fivefold increase in VTE risk, and thromboembolism is a major cause of peripartum death. Heritable thrombophilias are also important co-determinants of VTE risk in pregnancy. The mechanisms through which pregnancy and hormonal therapies increase VTE risk have not been definitively established, but hormonal effects on levels of coagulation and anticoagulation factors likely play a role. Venous compression and venous injury also contribute to increased risk during pregnancy and the puerperium. Approaches to diagnosis of VTE in the pregnant woman are largely the same as in the nonpregnant patient, but special treatment considerations do apply.Warfarin is embryopathic, particularly between the 6th and 12th weeks of pregnancy, and should be avoided in favor or heparin or low-molecular weight heparin when treatment of the pregnant woman is necessary. Guidelines have been published to assist the clinician in decision making about prophylaxis of pregnant women at increased risk or pregnancy-related or post-partum VTE.     

Potential uses of an infodemiology approach for health-care services for rheumatology

Clinical Rheumatology - This is a demand-based infodemiology study using the Google Trends and AdWords tools to illustrate infodemiology’s potential use in rheumatology. The study...     

Sonographic training in rheumatology: a self teaching approach

OBJECTIVE: To evaluate a self teaching approach to be followed by a novice without previous practical experience in musculoskeletal ultrasonography. METHODS: The novice was given short general training (two hours) by an experienced sonographer focusing on the approach to the ultrasound equipment, and asked to obtain the best sonographic images of different anatomical areas as similar as possible to the "gold standard" pictures in the online version of the guidelines for musculoskeletal ultrasonography in rheumatology (free access at http://www.sameint.it/eular/ultrasound). At the end of each scanning session, both novice and tutor scored "blindly" all the images from 0 (the lowest quality) to 10 (the highest quality), with a minimum quality score of 6 considered acceptable for standard clinical use. The tutor then explained how to improve the quality of the pictures. Fourteen consecutive inpatients (seven with rheumatoid arthritis, three with psoriatic arthritis, two with reactive arthritis, and two with osteoarthritis) and five healthy subjects were examined. Ultrasound examinations were performed with a Diasus (Dynamic Imaging Ltd, Livingston, Scotland, UK) using two broadband linear probes of 5-10 and 8-16 MHz frequency. RESULTS: Sonographic training lasted one month and included 30 scanning sessions (24 hours of active scanning). 243 images were taken of the selected anatomical areas. The mean time required to produce each image was 6 minutes (SD 4.2; range 1-30). At the end of the training, the novice scored >/=6 for each standard scan. CONCLUSION: A novice can obtain acceptable sonographic images in 24 non-consecutive hours of active scanning after an intensive self teaching programme.     

Sex and gender in older adults' experience of Parkinson's disease

OBJECTIVES: This article reports on the gendered experience of Parkinson's disease (PD). Data derived from 15 months of ethnographic study among community-dwelling older adults living with PD in eastern Iowa. METHODS: The study utilized several methods: participant observation at PD support group meetings, illness narrative interviews with PD sufferers, and a questionnaire. RESULTS: A total of 171 PD sufferers (106 men, 65 women) enrolled in the study. Illness narratives revealed gender differences in the impact of specific symptoms on daily life: Women's narratives emphasized the impact of the on/off effect and "thinking problems," whereas men's narratives emphasized the consequences of their physical appearance. In comparison, quantitative data found little sex difference in symptomatology. DISCUSSION: The comparison of qualitatively and quantitatively derived data reveals the importance of attending to both sex and gender. Qualitative data demonstrate how the meaning of PD symptoms is gendered and illustrate an example of how gender and sex research differ. All narratives reflect the importance of role continuity, but men's put at the forefront appearance and social isolation whereas women's underscore their relational aspects of domestic activities. These data imply that providers must look beyond symptomatology to the gendered saliency of particular somatic phenomena.     

Sex and gender differences in lung development and their clinical significance

Factors that affect airway growth-as early in development as in utero-seem to cause physiologic effects that can be persistent. Reduced airway function early in life does not necessarily result in persistent symptoms, but it does increase the risk of reduced lung function and the development of persistent airflow limitation in adult life, both in men and women. Normal lung growth varies with age and sex and is affected by a number of risk factors, which we have described. The importance of the various risk factors may differ depending at what point during lung growth they come into play and whether they occur in men or in women.     

Sex hormone and gender difference--role of testosterone on male predominance in Brugada syndrome

Introduction: The clinical phenotype is 8 to 10 times more prevalent in males than in females in patients with Brugada syndrome. Brugada syndrome has been reported to be thinner than asymptomatic normal controls. We tested the hypothesis that higher testosterone level associated with lower visceral fat may relate to Brugada phenotype and male predominance.
Methods and Results: We measured body-mass index (BMI), body fat percentage (BF%), and several hormonal levels, including testosterone, in 48 Brugada males and compared with those in 96 age-matched control males. Brugada males had significantly higher testosterone (631 ± 176 vs 537 ± 158 ng/dL; P = 0.002), serum sodium, potassium, and chloride levels than those in control males by univariate analysis, and even after adjusting for age, exercise, stress, smoking, and medication of hypertension, diabetes, and hyperlipidemia, whereas there were no significant differences in other sex and thyroid hormonal levels. Brugada males had significantly lower BMI (22.1 ± 2.9 vs 24.6 ± 2.6 kg/m²; P < 0.001) and BF% (19.6 ± 4.9 vs 23.1 ± 4.7%; P < 0.001) than control males. Testosterone level was inversely correlated with BMI and BF% in both groups, even after adjusting for the confounding variables. Conditional logistic regression models analysis showed significant positive and inverse association between Brugada syndrome and hypertestosteronemia (OR:3.11, 95%CI:1.22–7.93, P = 0.017) and BMI (OR:0.72, 95%CI:0.61–0.85, P < 0.001), respectively.
Conclusions: Higher testosterone level associated with lower visceral fat may have a significant role in the Brugada phenotype and male predominance in Brugada syndrome.