Why Women Get Rheumatoid Arthritis More Than Men

Rheumatoid arthritis — or RA — is an inflammatory, autoimmune condition. RA happens when a person’s immune system becomes confused, attacking its healthy cells. It primarily affects the joints. But it can cause damage to other body parts as well.

While anyone can develop RA, women are more likely to develop it. The exact cause of RA is unknown. But researchers have associated it with genetics, environmental and lifestyle triggers, and hormones. Read on to learn more. 

How common is rheumatoid arthritis in women?

An estimated 1.5 million people in the U.S. have RA, but it’s especially common in women. According to research, women are three times more likely than men to develop it. While you can get RA at any age, it most commonly begins between 30 and 60 years of age. 

Research suggests that women are most likely to be diagnosed with RA around the time of menopause. For many women, the first symptoms of RA occur around 45 years of age. And menopause occurs around 49 years of age. 

What are the symptoms of rheumatoid arthritis in women?

The symptoms of RA are the same for both women and men. Inflammation of the joints due to RA can cause symptoms such as:

• Pain

• Swelling

• Stiffness

• Warmth 

• Redness 

RA commonly affects joints on both sides of the body. It usually starts in small joints, including those in the:

• Hands

• Wrists

• Fingers

• Feet

But RA isn’t always limited to the joints. There are a variety of other early symptoms associated with RA, including: 

• Feeling tired (fatigue)

• Loss of appetite

• Fever

• Dry mouth and eyes

• Rheumatoid nodules (small, firm bumps under the skin) 

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Symptoms may come and go in what’s called a “flare-up.” Or they can appear and stay. Either way, the symptoms can be very uncomfortable and cause most people to seek medical care. 

Other types of arthritis can cause similar symptoms, so talk to a healthcare professional if you experience any of these symptoms.

The role of hormones in rheumatoid arthritis

The link between hormones and autoimmunity is complex, and the data is often conflicting. 

Research suggests that female hormone shifts at different stages of life may play a role in the development of RA. For example, estrogen levels decrease in menopause. So do progesterone levels after giving birth (post-partum). The decreases in both cases are linked with developing RA. 

But high levels of these hormones during pregnancy may be protective against RA. 

Here’s what some of the research shows on hormones and RA:

• Pregnancy: Pregnancy can help with RA symptoms, according to studies. For women already diagnosed with RA, symptoms tend to improve for about 60% during pregnancy. But the symptoms worsen (or flare) in almost half of women after delivery. 

• Menopause: As mentioned above, post-menopausal women have a higher risk of developing RA compared to premenopausal women. The risk is even higher for those who experience early menopause (before age 45). 

• Oral contraceptives: There’s mixed evidence on whether oral contraceptives like birth control pills can help with RA. Some studies have shown that using oral contraceptives lowers your risk of developing RA. This is especially true when the birth control is taken for an extended time (more than 7 years). But other studies don’t show that oral contraceptives have this same protective effect. 

• Hormone replacement therapy (HRT): Some studies have shown that HRT may be linked with an increased risk of RA. Meanwhile, others have shown that combined HRT (estrogen plus progesterone) can lower the risk. One study showed that post-menopausal women using HRT combined with RA medications had a higher likelihood of their symptoms going away (remission). 

It’s important to know that hormones aren’t the only factor at play in the development of RA. Factors like genetics and environmental triggers also contribute. More research is needed to understand the relationships between the immune system and other factors. 

Genetic risk factors for RA in women

Certain genetic factors may also increase the risk of RA in women. Here are some examples of how this can happen.

Chromosomes

Biologically, most females have two X chromosomes while males have one X and one Y. These contain copies of genetic material. For females during early development, one of their X chromosomes is inactivated.

But sometimes that inactivation isn’t complete. This means that some X chromosome genes are more active than they should be. This includes many immune-system genes, which can increase the risk of developing RA. 

Interleukin-4

Studies show that females with RA may have less interleukin-4 (IL-4) compared to males with RA. IL-4 is a chemical signal that helps lower inflammation. Having less IL-4 may increase the risk of developing RA. 

Does rheumatoid arthritis affect men and women differently?

Yes, in part. Everyone will have similar treatments and RA-related symptoms. However, research suggests that RA may be more aggressive in women. Women with RA tend to experience more disability and a greater impact on their quality of life. 

These effects could be worse later in life. Researchers have found that, in people with RA, there’s a functional decline after menopause. This means that they start having trouble doing daily activities independently.

We know a lot about how common RA is. However, there’s more to learn about its causes and which treatments work the best, as well as how the disease affects quality of life.

How is rheumatoid arthritis treated in women?

While there isn’t a cure, many effective treatments and medications for RA are available. For the most part, the treatment strategy is the same for women and men. 

The goals of treatment are to:

• Reduce pain and inflammation

• Prevent damage to joints and other organs

• Maintain and improve functioning and well-being

Here are some commonly prescribed medications for RA: 

• Disease-modifying antirheumatic drugs (DMARDs), like methotrexate (Rheumatrex) or hydroxychloroquine (Plaquenil)

• Biologic medications, like adalimumab (Humira) or etanercept (Enbrel) 

• Nonsteroidal anti-inflammatory drugs (NSAIDs) and glucocorticoids (steroids), which may be helpful early to control symptoms and when symptoms flare 

Available treatments can help to decrease joint damage and pain while improving mobility. Remission — having no symptoms —– is more likely with early and aggressive treatment.

Steps to take to prevent rheumatoid arthritis

There’s no proven way to prevent RA. But there are ways to reduce your risk and prevent disease progression. 

Smoking and obesity increase your risk of developing RA. These lifestyle factors can also make RA medications not work as well. So quitting smoking and maintaining a comfortable weight may help reduce your risk of RA. But it’s easier said than done. Consider reaching out to a healthcare professional if you need help.

Other lifestyle changes may help to decrease your risk of RA, although they haven’t been well studied. Research should be able to provide more information on this in the near future. 

These steps can improve your overall health in the meantime:

• Taking good care of your teeth and gums

• Maintaining a comfortable weight

• Eating a well-balanced, anti-inflammatory diet

• Staying active

If you have RA and medications are part of your treatment plan, be sure to take them as directed. This will help prevent further damage to your joints and other organs.

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Written by:

Jewels Doskicz, RN, BA

Jewels Doskicz, RN, is an Arizona-based registered nurse with more than 20 years of hospital-wide clinical nursing experience. She has spent over a decade in medical writing and editing, with a focus on diabetes and autoimmune disease.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

Reviewed by:

Maria Robinson, MD, MBA

Maria Robinson, MD, MBA, is a board-certified dermatologist and dermatopathologist who has practiced dermatology and dermatopathology for over 10 years across private practice, academic, and telehealth settings. She is a fellow of the American Academy of Dermatology and the American Society of Dermatopathology.

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