While RA affects men and women in similar ways biologically, research shows some differences in how the disease presents, progresses, and affects overall health.
Age at Diagnosis
Men tend to be diagnosed with rheumatoid arthritis later in life than women.
“In general, men tend to get rheumatoid arthritis in their fifties and sixties, which is later than women, who typically present with RA between their thirties and fifties. It’s unclear why that is; it may be hormonally related, but that’s still being studied,” says Dr. Greer.
Because men develop the condition later, it can complicate the diagnosis and treatment because the symptoms may be mistaken for osteoarthritis or general aging-related joint problems.
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Greer notes that this delay can make treatment more challenging as well. “When men come in later, they may already have more stiffness, more functional limitations, or other health issues that make management more complicated,” he says.
Disease Activity and Symptoms
Research shows that women with RA report higher disease activity scores, more pain, and more disability than men, even when objective measures of inflammation are similar.
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In general, men with RA tend to have more swelling, joint damage, and objective signs of inflammation, says Greer, while women tend to have more pain, stiffness, and fatigue.
Treatment Response
Research suggests that men with rheumatoid arthritis may respond more quickly to certain treatments, especially when therapy is started early in the disease.
This doesn’t mean RA is less serious in men. Instead, experts believe that biological differences — factors like body composition, hormone levels, and how medications are processed in the body — may influence how treatments work and how quickly symptoms improve, particularly with biologic medications.
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When men and women are treated using the same aggressive, treat-to-target approach, long-term outcomes such as joint damage and sustained remission appear similar, even if medication adjustments differ along the way.
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Heart and Lung Complications
Men with RA may face higher risks of certain comorbidities (coexisting conditions), particularly involving the heart and lungs, says Greer.
While the risk of cardiovascular disease is higher for everyone with RA, there’s evidence that men are at greater risk of cardiovascular disease than women, including heart attack and stroke, he says. All of the reasons for that aren’t clear, but it’s due in part to men having more uncontrolled heart disease risk factors, such as high cholesterol and high blood pressure.
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“It’s also more common for men with rheumatoid arthritis to get inflammatory lung disease called interstitial lung disease, especially men with RA who smoke,” says Greer.
Interstitial lung disease causes inflammation and scarring in the lungs that makes it harder for oxygen to move into the bloodstream. Over time, the scarring is permanent and can raise the risk of serious, even life-threatening complications such as pulmonary hypertension, lung infections, and respiratory failure.
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“RA is not just a joint disease. For everyone, but men especially, we’re paying very close attention to heart health and lung symptoms, because those complications can have a big impact on long-term outcomes,” says Greer.
Emotional Impact of RA on Men
The emotional and psychological effects of RA can differ sharply between men and women, shaped in part by social expectations around masculinity, work, and stereotypes about how men have to be tough or stoic.
Research suggests that men with RA often feel pressure to appear strong and self-reliant, leading some to minimize their symptoms or delay seeking help. In interviews, men described hiding their condition at work, pushing through pain, and struggling with the loss of physically demanding roles that were central to their identity.
“Many men may feel like they’re supposed to just deal with it — they may not talk openly about pain, fatigue, or emotional stress, even when it’s affecting their quality of life,” says Greer.
Work and productivity play an especially large role. Studies show that men with RA often link their self-worth to employment and physical capability, making work disability or early retirement particularly distressing.
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RA can also affect sexual health and intimacy, due to pain, fatigue, and reduced mobility, which some men may be reluctant to talk about with their provider.
“I always encourage my male patients to bring these issues up. They’re common, they’re treatable, and they’re an important part of overall well-being,” says Greer.
