Methotrexate blocks the metabolism of folic acid, a nutrient important for the division of cells in the developing fetus, says Dr. Pappas. “Methotrexate may get into the baby’s system” if the father is taking the drug when he conceives a child, so a clear discussion about avoiding conception, including the diligent use of contraception during sexual activity, is important to have with male patients, he says.

Other DMARD options for men with RA include sulfasalazine (Azulfidine), but this drug can lower sperm count, so the male patient’s child-making plans must be discussed, Dr. O’Dell adds. This effect on sperm is reversible. He notes that RA and its various drug treatments present a much greater challenge in female patients. “In women, we have the whole issue of pregnancy and nursing,” and females often must come off their drugs for a year or more, during which time their RA may flare. “There could be accumulated joint damage in this period for women,” says Dr. O’Dell.

Compliance Challenges

While men and women may experience RA in much the same way, there are some subtle differences in lifestyle or communication that rheumatologists note.

“Men may be more likely to be involved in work that involves physical labor,” says Dr. Pappas. Construction or other occupations that require heavy lifting or manipulation of large equipment could be difficult if a man’s RA is not controlled. This trend may have been more of a concern for rheumatologists in the past than now, Dr. Pappas adds. “The medications for RA that we have today are so powerful that we can usually get these men back to work as if they didn’t have rheumatoid arthritis, possibly in a few weeks.”

Twenty years ago, men receiving an RA diagnosis would worry about their ability to keep working or living an active, normal life, but now, rheumatologists can express optimism about their ability to control the disease, Dr. Pappas says.

One difference that Dr. O’Dell notices is some male patients, particularly those who are older men, is a too-casual approach to their disease. Compliance can be an issue for men with RA if they don’t take their disease seriously just because it seems controlled.

“I may have to work a bit harder for that man with RA to take it seriously,” he says. “Perhaps not if he’s lucky enough to be married to a woman who’s going to ensure that he takes his medications. I have more male patients whose wives run that part of their care. For whatever reason, women tend to be the ones to take responsibility for health care in couples, but usually, these people are older.”

Recommendations about regular physical activity for RA patients are the same for men and women, Dr. O’Dell adds. Exercise, including those that maintain cardiovascular health, strength and range of motion, helps keep joints flexible and overall health in good condition. Improved physical function may encourage male RA patients to be compliant with both medications and exercise suggestions, says Dr. O’Dell.

“I have so many men coming into my office talking about their golf games. When men refer to taking their therapy or not, and I guarantee that they’d lower their handicaps if they did their therapy, then that does the trick.”