This article is the first in our 6-part series on Women & Arthritis. Throughout the year we will feature stories about women’s experiences with arthritis, emerging research to help improve the quality of life of women living with arthritis, as well as information related to pregnancy and parenting. Subscribe to our flourish newsletter or be sure to check back on our site to make sure you don’t miss any important information!
Why Do More Women Than Men Have Arthritis?
An Overview of Women and Arthritis
Arthritis doesn’t play fair—including how it affects women and men differently. One in four Canadian women is living with arthritis, compared to one in six Canadian men. And while nearly 60% of women over age 65 have arthritis, the disease affects them at younger ages too, particularly those with a diagnosis of rheumatoid arthritis (RA) and lupus. While a number of factors have been connected to higher rates of arthritis in women, further research needs to be done to better understand the issue.
Research suggests that the impact of arthritis can differ between the sexes: women with arthritis often report higher levels of sleep difficulties, stress, disability and depression compared to men living with arthritis, or women living with other chronic diseases. “I think women may tend to have more disability because they do a lot at home and at work,” says Dr. Angela How, a rheumatologist in Burnaby, BC, referring to women living with RA. “Women’s roles are so diverse and I think that we sometimes forget about that. In addition to work, there’s also home, child-raising and leisure activities.” According to Statistics Canada’s Women in Canada report(2017), while women’s paid labour rates have increased significantly in the past 30 years, for those with children, the gender gap in child care has remained constant. In 2010, “women spent nearly one hour more per day on routine child-care tasks than their male counterparts” and women were three times more likely than men to provide care to an adult family member or friend.
Let’s take a closer look at some of the physiological factors that are involved when it comes to women and arthritis.
The autoimmune connection
Many forms of inflammatory arthritis are due to autoimmune disease (a form of disease where the body mistakenly attacks healthy tissue), and autoimmune diseases of all kinds tend to affect women at much higher levels. Nine out of 10 people living with lupus, for example, are women. Frustratingly, however, it’s not clear why.
More women than men have osteoarthritis (OA), and there is an increase in OA after menopause when estrogen levels dip, leading some researchers to theorize that estrogen can help prevent cartilage inflammation and damage. Menopause is also associated with a greater tendency towards weight gain, which can put strain on joints as well. However, there aren’t clear-cut answers. “There are really a lot of conflicting results in the research that has been done so far. No conclusions can be made about hormone replacement and OA. Being on the birth control pill doesn’t seem to have any effect on the development of OA,” says Dr. How. “The answers are not there yet, unfortunately.”
When it comes to RA, Dr. How says that during pregnancy, when hormone levels are high, most women with RA go into remission, but experience a flare in the first few months after giving birth (breastfeeding may delay this flare in some cases). At menopause, women who are not on hormone replacement therapy (HRT) are at higher risk of developing RA.
“We also know that androgen levels, like testosterone, are lower in both male and female patients with RA. I think it’s a complex interplay between all the different types of hormones that we have.”
Genetics can also play a role. “One widespread type of OA that affects knees, hips and hands is more common in women. Your risk of this type of arthritis is greater when you have female relatives who also have it,” says Dr. How. However, if you have a first degree relative (such as your mother or your father) with RA, both you and any male siblings have a higher risk of developing RA yourselves. Research suggests that certain gene variations can increase susceptibility to lupus as well.
People with knee injuries involving the anterior cruciate ligament (ACL), one of the major ligaments in the knee, have a higher incidence of developing OA later in life, whether or not the injury is repaired by surgery. And, because of the physical make-up of women’s knees, women are at higher risk of ACL injuries.
Bottom line: it’s complicated. “There are many factors. We don’t actually know what causes most forms of arthritis. It’s a complex interrelationship between genetic factors and environmental factors,” says Dr. How. Hopefully future research can help answer some of the questions that remain. So while the exact causes are not always evident, at minimum it can be helpful to be aware of the elements that are at play, and to not ignore or explain away symptoms. Talk to your health care provider to work on getting a proper diagnosis and treatment or explore the Arthritis Society’s resources at arthritis.ca/education to help you self-manage your condition.