Looking Beyond Gender Issues

Men and women. Kings and queens. Ladies and gentlemen. Since the beginning of humankind, society has divided us based on gender, teaching us how to act and what to say. X chromosomes line up over here, Y chromosomes over there.

But what about autoimmune diseases and the way in which they are diagnosed and treated? Should we be taking our cues from society and determine care based on gender, or is there insufficient evidence to do so?

Before we answer that question, let’s take a step back and look at some of the variables and pathways our patients follow to get to the rheumatology clinic.

Here is a common one—we’ll call this Patient A. Patient A breaks out in a rash on the inside of their elbows that doesn’t go away, but it’s chalked up to dry, wintertime skin. They go on with their life not thinking much about the rash, until a few months later when the same rash breaks out on their ankles. Or maybe the rash goes away but they start to develop mild joint pain in a few large joints that is initially chalked up to overdoing it while playing with the kids but doesn’t get any better after several months.

Finally, after a year or so, the patient realizes “something just isn’t right,” and goes to see their primary care provider (PCP), who refers to rheumatology. Labs are ordered. So is a skin biopsy. X-ray are taken. Results are conclusive—this patient has an autoimmune disease. An official diagnosis is made that leaves the patient shellshocked and in a state of denial. “But I don’t ever get sick. This can’t be happening to me.” The patient is hesitant about starting treatment—remember that they are having trouble simply coming to terms with their diagnosis. The patient’s gender really isn’t important at this point. We have to start treatment of any kind to see if there will be a response, and it’s often a long battle to get their disease under control. My clinical experience is that this patient with this set of issues is more likely to be a man than a woman, though certainly it can skew both ways.

“We’re learning more and more that we need to individualize therapy based on a wide variety of factors and clinical experience.”

Now what about this scenario, which we’ll call patient B? This is a patient who develops unusual changes to their fingernails along with random, plaque-like areas on their skin and mild joint pain. This is a patient who cares a lot about their appearance—while more likely to be a female, I have lots of male patients who fit this profile as well. This patient is sometimes referred to us by their PCP, but more frequently by a dermatologist since their primary issue is their physical appearance.

This is a patient where we’re able to intervene quickly because symptoms weren’t ignored, and we’re able to get the patient’s disease into remission (or near-remission) within 6 months of starting medication.

Because of the physiological differences between the sexes, there is some logic to variability in treatment responses based on gender, but that’s not the way we commonly approach treatment in our rheumatology patients. We’re learning more and more that we need to individualize therapy based on a wide variety of factors and clinical experience. While “Patient A” may most frequently be a man in our practice, I certainly have seen plenty of women who ignore “a little rash” and chalk it up to dry skin before things start to escalate. It’s the same with “Patient B,” who is often female, though there have been plenty of men I have seen over the years who have gone quickly to their PCP or dermatologist when they notice an abnormal skin rash. It simply isn’t possible to throw patients into separate buckets based on gender alone.

So then if gender isn’t the determining factor behind whether or not a patient responds to therapy, what does make a difference? Based on my experience, it comes down to three things—patient education, patient understanding, and patient adherence to therapy. Our job as rheumatology nurses is to develop the rapport with patients that motivates them to work with us—and not against us—to help manage their disease.

There are so many patients of both genders who have come to my practice feeling lost and frustrated. Sometimes it’s about a circuitous diagnostic journey, while in other instances, it’s more an issue of being asked to try, try again when medication after medication fails to help solve their issues. By doing little things like listening, re-explaining key concerns, and recruiting the patients’ family and friends to help them out in times of crisis, we can be the cheerleader that our patients need to stop and potentially reverse the damage that their disease has caused.

It is so important to get our patients to understand that they don’t have to overhaul their lifestyle just because they have been diagnosed with an autoimmune disease and that we certainly can get them to live comfortably if they will agree to work with us. It’s a team effort from that first interaction through the course of years of treatment and adjustments. Regardless of gender, every patient should be offered (and sometimes really need) that TLC to provide the reassurance that lets them know that they are in the right place, at the right time, with the right people, to get the right treatment.

Joni Fontenot, RN

Author Bio: Joni Fontenot, ASN, RN, is an RN Staff Nurse at Ochsner Health System – The Grove – Infusion/ Rheumatology Infusion in Baton Rouge, LA, and Chapter Development Chair on the Rheumatology Nurses Society Board of Directors.

Participants will receive 2.25 hours of continuing nursing contact hours, including 1.25 nursing pharmacotherapeutic hours, by completing the education, completing an online evaluation, and receiving a post-test score of 70%: RNP V6 Issue 4: Battle of the Sexes: The Differences Between Men and Women with Psoriatic Arthritis

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