Gender-specific impact of follow-up intervals on disease control in rheumatoid arthritis: a nationwide analysis of 15 835 Chinese patients.

Abstract

Previous studies have identified unique challenges for RA patients of different genders, which impact disease management. However, the association between disease activity and health-care-seeking behaviours in male and female RA patients remains underexplored. This study aimed to investigate this association, with a specific focus on the gender-specific effects of follow-up intervals on disease control. A nationwide survey (July-September 2023) across 330 rheumatology centres in China included 13 278 female (83.85%) and 2557 male RA patients (16.15%) aged ≥18 years. Standardized questionnaires captured demographic and health-care-seeking behaviours. Disease activity was assessed using the Clinical Disease Activity Index (CDAI). Females had younger disease onset (45.84 vs 51.03 years, P < 0.001), longer disease duration (7.51 vs 5.64 years, P < 0.001), higher low disease activity/clinical remission rates (22.61% vs 15.33%, P < 0.001), and lower glucocorticoid use (39.5% vs 47.73%, P < 0.001). Despite similar self-reported regular follow-up rates (84.73% vs 83.14%), both genders experienced suboptimal visit intervals (>3 months: 61.30% vs 62.65%, P < 0.001). Prolonged follow-up intervals were independently associated with poor disease control (CDAI > 10) in the female subgroup, with longer intervals linked to higher odds of inadequate control at 6-month [odds ratio (OR) = 1.22, 95% CI: 1.09-1.37, P < 0.001] and 12-month intervals (OR = 1.43, 95% CI: 1.22-1.60, P < 0.001). Regular monitoring reduced high disease activity risk across genders (OR = 0.64, 95% CI: 0.56-0.74, P < 0.001). A generalized linear model showed no significant follow-up interval - gender interaction on disease activity (all P > 0.20). This large-scale study revealed gender-dimorphic patterns in RA progression and health-care engagement. Females tended to exhibit better treatment response, with a more pronounced interval-dependent disease control trend. No significant interval-gender interaction confirmed this was a descriptive trend, not a validated gender-specific difference. Our findings emphasize the need for strategies accounting for such gender-dimorphic trends to optimize care continuity and improve RA management.