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 rheumatoid arthritis (RA) patients of different genders, which impact disease management. However, the association between disease activity and healthcare-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 2,557 male RA patients (16.15%) aged ≥18 years. Standardized questionnaires captured demographic and healthcare-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 (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 reveals gender-dimorphic patterns in RA progression and healthcare engagement. Females tended to exhibit better treatment response, with a more pronounced interval-dependent disease control trend. No significant interval-gender interaction confirms this is 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.