If you have psoriatic arthritis (PsA), you’re no stranger to joints that hurt or swell, as well as a variety of other symptoms. Both men and women are diagnosed with this autoimmune arthritis in similar numbers. But their experiences with the disease are often very different.
Your gender can have an effect on your diagnosis, symptoms, and response to treatment. Learning how it plays a role can help you slow psoriatic arthritis and pump the brakes on joint damage.
Gender Differences in PsA: Diagnosis
There's no single test to diagnose PsA. Doctors depend on imaging tests, physical exams, and your medical history to make a diagnosis. You will probably also get a blood test to rule out rheumatoid arthritis.
A timely diagnosis is your first step to getting the upper hand on your disease.
A recent review of multiple studies shows that women get their psoriatic arthritis diagnosis about 10 years later than men. In general, American men are diagnosed in their 40s and women in their 50s.
A few things could explain this:
- Doctors may suspect health problems common in women like osteoarthritis, rheumatoid arthritis, or fibromyalgia before testing for psoriatic arthritis.
- Doctors also may misdiagnose these complaints of pain as depression, especially in women.
- Psoriatic joint damage affects men at an earlier age and can be seen on X-ray clearly. This may be due in part to the fact that men tend to have higher-impact physical occupations and sports activities, which inflames joints.
- Women’s PsA isn’t easily seen on X-ray in its early stages. More sensitive imaging tests like ultrasound or MRI may be needed for diagnosis.
Symptoms of Psoriatic Arthritis in Men and Women
Typical PsA symptoms in men include:
- Arthritis that affects the spine, causing back pain and stiffness
- More severe skin psoriasis, which can also impact the nails
Typical symptoms in women include:
- Arthritis pain and stiffness in arms, hands, legs, and feet
- A higher number of swollen and painful joints than men have
Men generally report a better quality of life and less disability at work. Women have more pain, fatigue, and poorer function than men. Other conditions common in females, such as fibromyalgia, may play a role in ability to function as well. If you have PsA, ask your doctor whether you should have an ultrasound to check for another health problem.
Treatments and Outcomes by Gender
Disease modifying antirheumatic drugs (DMARDs) fight inflammation, reduce pain, and lessen joint damage. Men typically respond well to this advanced treatment. DMARDs tend to be less effective for women and cause worse side effects that make them stop the treatment. As a result, they aren’t as likely as men to reach remission.
Talk to your rheumatologist if your medication isn’t working for you. There are many options available.
Family Planning and PsA
If you’re a man and want to have children in the future, it’s important to have a conversation with your doctor to find out any limitations you may face. A 2017 study found that untreated psoriatic disease could affect male fertility. Chronic inflammation can lower levels of testosterone and other male sex hormones. It also can affect sperm count and motility.
PsA doesn’t typically affect a woman’s ability to conceive kids.
Let your rheumatologist and your dermatologist know if you’re thinking about having a baby, even if it’s months from now. You and your doctor will need to look at your medications closely to make sure they’re safe for a fetus.
Methotrexate is a common drug used for psoriatic arthritis. Since It carries a small possibility of birth defects, doctors recommend that both men and women stop this drug at least 3 months before trying to conceive.
If you have an unplanned pregnancy, get in touch with your doctors right away. You’ll need to make a plan to manage your arthritis and protect your unborn baby.
What to Expect When You're Expecting With PsA
You may get a reprieve from your arthritis while pregnant. About 40%-60% of women with psoriatic disease see their symptoms get better during pregnancy. Doctors think this may be because of hormonal shifts and changes in your immune system.
But be prepared for your symptoms to come back within 3 months after you give birth. It's smart to have a treatment plan in place to deal with a flare-up of arthritis. Talk to your health care team. Ask family or friends to help take care of the baby or prepare meals just in case a flare is very bad.
Be aware of your moods too. Depression is common in psoriatic arthritis and in the weeks after giving birth.
PsA and Menopause
Having PsA may mean you start menopause earlier than average. Hormone shifts during the phases of perimenopause and menopause can lead to symptom flares. Both PsA and menopause can make getting enough sleep a challenge and bring on extra fatigue.
Show Sources
Photo Credit: Adam Kazmierski / Getty Images
SOURCES:
Cleveland Clinic: "Disease-modifying antirheumatic drugs (DMARDS)."
Dermatology: “Untreated Psoriasis Impairs Male Fertility: A Case-Control Study.”
Jacob Hascalovici MD, PhD, chief medical officer, Clearing.
Johns Hopkins Arthritis Center: “Psoriatic Arthritis Diagnosis.”
National Psoriasis Foundation: “Psoriasis, Psoriatic Arthritis, and Pregnancy."
Nature Reviews Rheumatology: “Sex- and gender-related differences in psoriatic arthritis.”
The Psoriasis and Psoriatic Arthritis Alliance: “Fertility and Pregnancy.”
