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Rheumatoid arthritis (RA) is more common in women than in men. Learn the symptoms and seek care early if you think you may have RA.

Rheumatoid arthritis (RA), is an autoimmune disease that primarily affects your joints.

It can develop at any age but occurs more often in older people. More than half of people living with RA receive their diagnosis after they are 65 years of age.

While autoimmune conditions can affect anyone, they usually occur more often in women than men. For people younger than 50 years of age, RA prevalence can be 4-5 times higher in females than males. In populations older than 60-70 years of age, women develop RA twice as often as men.

Read on for more information about the symptoms, risks, genetics, and treatment of RA in women.

Language matters

You’ll notice we use the binary terms “woman” and “man” in this article. While we realize these terms may not match your gender experience, these are the terms used by the researchers whose data was cited. We try to be as specific as possible when reporting on research participants and clinical findings.

Unfortunately, the studies and surveys referenced in this article didn’t report data for or may not have had participants who are transgender, nonbinary, gender nonconforming, genderqueer, agender, or genderless.

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Symptoms of RA occur because your immune system mistakenly attacks the lining of your joints, called the synovium. This autoimmune response causes pain and inflammation and can affect multiple areas of your body.

RA symptoms include:

  • joint pain, swelling, tenderness, stiffness
  • joint symptoms that have been present for at least 6 weeks
  • stiffness in the morning for at least 30 minutes
  • symptoms that occur in more than one joint, and usually affect both sides of the body
  • symptoms that appear in small joints first
  • fatigue
  • low-grade fever

Symptoms like pain and inflammation can lead to additional health effects, including:

  • weight gain
  • elevated cholesterol
  • hypertension
  • diabetes
  • metabolic syndrome
  • cardiovascular disease
  • lung disease
  • shortness of breath
  • eye symptoms, including dryness, redness, and light sensitivity
  • mouth issues such as dryness, gum inflammation, and infection
  • skin lumps known as rheumatoid nodules
  • blood vessel damage leading to skin, nerve, and organ damage
  • low red blood cell count
  • osteoporosis
  • Felty syndrome (a rare RA complication featuring white cell changes and spleen enlargement)
  • sleep disorders

In addition to physical symptoms and health effects, people living with RA may have an increased chance of experiencing mental health issues.

A 2022 study found a link between RA and depression and anxiety. Participants with RA had a higher mean score for both mental health issues than the unaffected controls.

The study also found that 71% of participants with RA had received a psychiatric diagnosis, compared to a depression or anxiety diagnosis rate of 7.1% in the control group.

A 2019 review and meta-analysis found a link between RA and bipolar disorder (BD). The authors theorize that chronic inflammation could be a contributing factor.

Research suggests that the effect of sex hormones combined with environmental and genetic factors could explain the higher prevalence of RA in women.

Not only do more women than men get RA, but women also tend to experience symptoms at a younger age, which may be more severe.

Women tend to receive a diagnosis slightly earlier than men, potentially due to hormonal changes that occur in their mid-30s and again after their mid-40s.

The levels of various hormones in your body change throughout your lifetime. Factors that can affect these levels include:

Research indicates that pregnancy and breastfeeding may reduce your risk of developing RA.

If you have been diagnosed with RA, it’s important to use birth control and speak with your doctor prior to conceiving. This is because of the potential effects to an unborn baby from certain RA medications.

For example, methotrexate, a medication commonly used to treat RA, can cause injury to a developing baby’s head, face, arms, legs, and bones.

Your rheumatologist can help you prepare for pregnancy and manage your medications and treatment during pregnancy.

Researchers believe that the combination of genes and environment lead to RA, and that genetics play a significant role in whether you develop this condition.

The heritability of RA is approximately:

  • 40-65% for seropositive RA (the presence of antibodies known as anti-cyclic citrullinated peptides in your blood)
  • 20% for seronegative RA (anti-cyclic citrullinated peptides don’t appear in blood tests)

First-degree relatives of people living with RA have a higher chance of developing the condition themselves.

On a cellular level, organelles called mitochondria produce the energy necessary for cellular metabolism. Research has found that mitochondrial dysfunction can increase a person’s chance of developing RA.

Being a woman can affect your genetic predisposition to developing RA.

  • X chromosome inactivation (XCI): During embryogenesis, females experience inactivation of one of their two X chromosome genes. As many as 30% of these genes escape during XCI, some of which increase your chance of developing an autoimmune disease like RA.
  • Cytokines: RA features inflammatory cells in joint synovium. Cytokines are proteins that can either increase or suppress inflammation. Research has found that the anti-inflammatory cytokine Interleukin-4 (IL-4) is less active in females than males.

Certain triggers can worsen RA symptoms, or cause symptom flares. Identifying and avoiding triggers may help you manage your symptoms.

Triggers include:

  • physical or emotional stress
  • poor sleep
  • overexertion
  • infection
  • cigarette smoke
  • silica
  • textile dust
  • asbestos
  • periodontal disease bacteria P gingivalis
  • intestinal microbiome changes

Sometimes symptom flares have no identifiable triggers. If you experience repeated unpredictable flares, your doctor may be able to help by adjusting your medication dose.

If you have any symptoms of RA, seeing a doctor for an assessment and diagnosis can lead to helpful treatment.

Leaving RA untreated can lead to more severe effects like joint deformity, disability, and even organ damage. However, early diagnosis can ease symptoms and reduce disability and disease progression. Sometimes treatment can cause RA to go into remission.

Rheumatologists diagnose RA, using:

  • your medical history
  • a physical exam
  • blood tests
  • imaging tests

Once you’ve received a diagnosis of RA, your doctor will create a treatment plan with goals that include symptom relief and the prevention of both joint damage and long-term complications.

To treat RA, doctors target pain and inflammation with medications, such as:

  • biological agents
  • glucocorticoids
  • disease-modifying antirheumatic drugs (DMARDs)
  • non-steroidal anti-inflammatory drugs (NSAIDs)

You might participate in therapy to increase muscle strength and maintain joint mobility. Assistive technologies can protect joints and allow you to function with more independence.

Surgery may also be an option, followed by rehabilitation.

Research suggests that younger people with RA are more likely to receive vigorous treatment. They are likely to begin this treatment earlier, have better outcomes, and receive prescriptions for disease-modifying antirheumatic drugs such as:

  • methotrexate
  • sulfasalazine
  • hydroxychloroquine
  • leflunomide

Self-care can also be helpful. Lifestyle areas like sleep, exercise, nutrition, and social support can all make a difference. RA education can provide you with useful coping strategies.

RA is a chronic condition, and there is no cure. But for some people, remission is possible with medication.

RA occurs more often in women than men, and an increased prevalence seems to be linked to hormonal, genetic, and environmental factors. However medical experts’ understanding of the disease continues to evolve.

If you’re experiencing any symptoms of RA, talk with your doctor.

They may refer you to a rheumatologist, a doctor who specializes in diseases that affect the joints and connective tissues, as well as a range of autoimmune diseases.