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

OBJECTIVES: 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. METHODS: 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). RESULTS: 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). CONCLUSION: 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.