Why is psoriatic arthritis worse in females than in males? 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Li, MD, FACR — By Jenna Fletcher on August 2, 2022Psoriatic arthritis (PsA) is a form of inflammatory arthritis that is part of psoriatic disease. Several factors can cause the symptoms to get worse, including sex assigned at birth. Females with PsA tend to have a worse overall outlook than males. They tend to have more severe disease activity, more debilitating pain, and a more significant loss of function. Alongside this, treatment is less likely to be effective in females. The differences in PsA outcomes occur despite the fact that the condition affects about the same number of males and females. This may indicate the need for future therapies to address sex-specific differences more effectively. This article reviews what experts know about the differences between females and males living with PsA. A note about sex and gender Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birthex assigned at birth. Click here to learn more. Differences between males and females Strong evidence suggests that females experience PsA differently than males. They often have a less positive outlook and report more disabling symptoms. Testing tends to show higher levels of disease activity and lower remission rates. Symptoms Although the types of symptoms do not vary much between males and females, their severity does. According to a 2021 study, females have a higher chance of experiencing:severe painhigher levels of fatigueincreased functional limitationslower quality of life They are also more likely to experience higher rates of spondylitis in the first 10 years from diagnosis. Spondylitis refers to pain associated with the spine and sacroiliac region. In a 2020 study, researchers reported that females had a higher rate of polyarthritis than males. Polyarthritis is the term for arthritis that affects five or more joints. However, they noted that females and males experience similar rates of:Dactylitis: This term refers to the swelling of fingers or toes, which gives them a characteristic sausage-like appearance.Enthesitis: Enthesitis is the inflammation of the entheses, areas of connective tissue between joints and muscles.Tenosynovitis: Tenosynovitis is the inflammation of the tendon. Inflammatory bowel disease: This umbrella term primarily describes ulcerative colitis and Crohn’s disease. Remission rates Several studies have shown that females have, overall, a lower remission rate and higher levels of disease activity. For example, studies from 2020 and 2021 noted both of these outcomes. A more recent study from 2022 confirmed the increased disease activity among females. These findings may indicate that males respond differently to standards of care and, as a result, have better outcomes. General prevalence PsA affects males and females in roughly equal numbers. About 30% of people living with psoriasis go on to develop PsA at some point in their life. Approximately 8 million people in the United States are living with psoriasis, suggesting that about 2.4 million people in the U.S. have PsA. Responses to treatment Evidence suggests that the difference between the outcomes of males and females with PsA may be due to different treatment responses. In a 2018 study, researchers found that tumor necrosis factor (TNF) inhibitors were more effective in treating males than females. TNF inhibitors are a type of biological medication that doctors often use as a first-line therapy. In a study from 2022, females who underwent the standard-of-care treatment showed some improvements. However, compared with their male counterparts, they experienced:higher disease activityhigher levels of painlower functional capacity The reduced effectiveness of standard-of-care treatments in females may help explain why these individuals have a lower rate of remission and higher disease severity than males. Reasons behind these differences Experts do not fully understand the exact cause of the differences between males and females when it comes to PsA, but they do have some theories. The authors of a 2022 study that looked at a large database of information on sex and PsA speculate that differences between the sexes may have to do with several non-linear causes, which may include:the genetic and biological makeup of the individual psychological variableshormonal components, such as menopausal status environmental exposures, such as skeletal physical stressingdifferences in how the environment interacts with a person’s genetics Summary PsA affects roughly the same number of males and females, but females tend to have a less positive outlook than males. Although the exact reason for this is not known, experts believe that it may be due to several differences between the sexes, including hormones, genetics, environmental exposures, and other possible variables. Females who receive a diagnosis of PsA should work closely with a doctor and strongly consider self-advocacy. If their treatment is not working, they can ask about other possible therapies that may be more effective. Last medically reviewed on August 2, 2022UncategorizedMedically reviewed by Margaret R. Li, MD, FACR — By Jenna Fletcher on August 2, 2022 More in Psoriatic Arthritis from the Inside OutThe connection between psoriatic arthritis and heart diseaseWhat's to know about psoriatic arthritis flare-upsTop 10 cold weather tips for psoriatic arthritisManaging psoriatic arthritis and fatigueView all Related CoverageHow does psoriatic arthritis affect the eyes?Medically reviewed by Brenda B. Spriggs, M.D., MPH, FACP Psoriatic arthritis (PsA) is an inflammatory condition that increases the risk of several eye conditions. Learn how PsA affects the eyes and how to…READ MOREWhat is the link between psoriatic arthritis and digestive issues? What to knowMedically reviewed by Brenda B. Spriggs, M.D., MPH, FACP Many people with psoriatic arthritis (PsA) also have inflammatory bowel disease (IBD). 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