Hani M Almoallim, Sami M Bahlas, Yasser Bawazir, Albadr H Hussein, Gamal Mahmoud Attia, Hanady Manasfi, Zain A Bafadhl, Raja Adib Bakhsh, Alhussain Mohammed Asiri, Ayda Rahma Ali, Mohammed M Alomair, Hanan Almalki, Mona Alsharaif, Muhammad Irfanullah Siddiqui, Aous S Alhazmi, Suzan M Attar
In this Saudi RA cohort, both sexes achieved high remission rates under treat-to-target management, and sex differences in disease activity did not persist after multiple-comparison correction. RF and ACPA, rather than sex, were the dominant predictors of remission.
PURPOSE: Rheumatoid arthritis (RA) affects women two-three times more frequently than men, and registries report sex-based differences in disease activity and remission. However, sex-stratified outcome data from Saudi Arabia are limited. We evaluated sex differences in disease activity, remission rates, and predictors of remission in the Rheumatoid Arthritis Saudi Database (RASD).
PATIENTS AND METHODS: We conducted a prospective cohort study of 647 patients with RA receiving biological or targeted synthetic DMARDs (574 female and 73 male) with at least 12 months of follow-up. Disease activity was assessed using DAS28-CRP, CDAI, FSS, and HAQ-DI across three visits. Remission was defined as DAS28-CRP <2.6. Linear mixed-effects models examined disease activity trajectories by sex, and multivariable logistic regression identified predictors of remission at visit 3. Benjamini-Hochberg correction was applied across six Stage-4 chi-square tests and across three pairwise sex comparisons within each outcome.
RESULTS: Overall remission rates rose from 50.9% at visit 1 to 83.5% at visit 3, with no significant sex differences after correction for multiple comparisons. DAS28-CRP declined significantly over time in both sexes (p <0.001). Males had higher adjusted CDAI at Visit 1 (13.43 vs 11.12; BH-adjusted p = 0.007), but not at visits 2 or 3; the visit-by-sex interaction was significant (unadjusted Type III p = 0.032). Fatigue and functional disability did not differ by sex. ACPA positivity was associated with higher odds of remission (OR 1.67, 95% CI 1.03-2.68, p = 0.036), while RF positivity was associated with lower odds (OR 0.61, 95% CI 0.38-0.96; p = 0.034). Sex was not an independent predictor.
CONCLUSION: In this Saudi RA cohort, both sexes achieved high remission rates under treat-to-target management, and sex differences in disease activity did not persist after multiple-comparison correction. RF and ACPA, rather than sex, were the dominant predictors of remission.