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Rheumatoid arthritis (RA) is more common in females than in males. 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 females than in males. For people younger than 50 years of age, RA prevalence can be 4 to 5 times higher in females than males. In populations older than 60 to 70 years of age, females develop RA twice as often as men.

Read on for more information about the symptoms of RA in females and what may affect them.

Language matters

You’ll notice, in some cases, that 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.

Although we typically avoid language like this, specificity is key 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 linked RA to depression and anxiety, finding that participants with RA had higher mean scores for both issues compared to unaffected controls. Additionally, 71% of those with RA received a psychiatric diagnosis, while only 7.1% in the control group were diagnosed with depression or anxiety.

A 2019 review and meta-analysis also 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 female sex hormones such as estrogen and progesterone could explain the higher prevalence of RA in women. How these hormones manifest in your body over the course of your life may also affect your symptoms and their severity.

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:

  • Pregnancy and postpartum: Research suggests that RA symptoms may improve during pregnancy. This is thought to be related to the immune system and the protective effect of hormones during this time, though the mechanism isn’t fully understood. After pregnancy, RA has an average flare rate of 46%.
  • Menopause: The exact connection between menopause and RA is still unclear. Some research suggests RA symptoms may worsen during menopause, while other research shows early onset menopause can result in milder symptoms. More study is needed for a better understanding.
  • Hormones taken after menopause: Some anecdotal studies have suggested that hormone replacement therapy could improve symptoms of RA, but others didn’t show any significant results.
  • Use of oral contraceptives: There’s some research to suggest that oral contraceptives may help reduce the severity of RA symptoms.

Research also suggests a link between RA and various female reproductive disorders, such as polycystic ovary syndrome (PCOS) and endometriosis. These conditions are related to hormones. That said, there is no research-based evidence to suggest that they can affect the symptoms of RA.

Note, also, that if you’ve 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 on 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.

Learn more: Rheumatoid arthritis and menopause.

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

In addition, being female can also 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 the 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.

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.

What’s the worst that can happen with rheumatoid arthritis?

RA can be managed with the right treatment. That said, having the condition puts you at a higher risk of heart problems and even heart failure.

What do people with rheumatoid arthritis have difficulty with?

There are a number of challenges of living with RA beyond the symptoms alone. The symptoms can be invisible, which means it can be difficult to explain to friends and loved ones. Some people will also experience mental symptoms such as brain fog or insomnia, which can also negatively affect day-to-day life.

Learn more: 13 things to know about living with rheumatoid arthritis.

Does rheumatoid arthritis hurt all the time?

Symptoms of RA can range in intensity and may appear and disappear. Sometimes, you may experience flares or times when the disease is more active. At other times, you may enter remission, where the swelling and pain subside or vanish completely.

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

RA occurs more often in females than males, 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.