Sex and gender differences in osteoarthritis with Dr Melissa Laitner

hello and welcome to this edition of joint action [Music] this podcast is dedicated to all those out there who have osteoarthritis on the show we unpack the truth and demystify the myths about the disease and its management if you have joint pain and want to know more about how to manage it from the world's best experts you've come to the right place without further ado it is time to welcome your host david hunter hello and welcome to this week's edition of the joint action podcast where we have the privilege of talking about sex and gender

differences in osteoarthritis osteoarthritis places a large burden on the individuals that are affected as well as to society as a whole but it's important to reflect on the fact that that burden is not distributed equally the prevalence of osteoarthritis is higher amongst women compared to men women also experience higher rates of disease severity and disability in an effort to better understand these disparities with the overarching focus being to improve health outcomes for all it's important to understand the influence of sex and gender differences in osteoarthritis clinical care and research that is the focus of this

week's issue of joint action and it's a privilege to be joined by melissa leitner melissa leitner phd mph is director of public policy and government affairs at the society for women's health research a washington dc-based non-profit with the goal of improving health care for women through science policy and education at the society for women's health research melissa manages all regulatory and legislative efforts transforming the work of scientific experts into tangible evidence-based policy recommendations prior to joining that society melissa worked as an american association for advancement of science health policy fellow in the office of senator

michael bennett in that role she worked on a wide-ranging portfolio with an emphasis on matters related to cms federal drug administration prescription drugs mental health and topics relevant to health healthcare transparency costs and coverage before entering the policy field melissa worked as a clinical health psychologist at a large academic medical center and we hope to get into that during the course of today's conversation she remains a licensed clinical psychologist in the district of columbia hello melissa and welcome to the show hi thanks for having me oh no it's absolutely our pleasure and it's a great

privilege to talk to you about what's really a very very important topic that will very be very relevant to most of our listeners now before we get into the main content the meat of the show i just wondered if we could get to know you a little bit better and in the first part of that can you just share with the listeners a little bit more about your background and what your typical day looks like yeah of course so clinically i was trained as a psychologist before i moved into policy in my current career so

i you know i'm from the states i worked in florida at a big academic health center and i worked with chronic disease patients so on my clinical practice lots of cancer lots of transplant chronic pain as well and working with patients who were hoping to make lifestyle changes and behavioral changes to better manage the symptoms of you know whatever diagnosis they had and so that was how i entered into healthcare and ultimately decided to transition into policy and helping folks from more of a systematic you know 30 000 feet level as opposed to the individual

patient perspective just because i felt like there were so many public health issues that needed to be addressed and that we needed to address more quickly than just trying to help one patient at a time so i transitioned into policy through a fellowship that brought me to capitol hill here in washington dc and working in the united states senate and now am director of public policy at a non-profit that works on women's health issues so that that's what i'm doing now my day-to-day is is really varied it's really mixed um i work on congressional legislative

issues so i'm an advocate and i work with the united states congress on topics that affect women's health you know asking for specific policy changes or you know giving policy recommendations on different health areas that really touch the lives of all women and i also do regulatory issues which means i work with federal agencies to you know rate policies whether internal or external policies about research and clinical trials design about how we can make sure the science we're doing here is really inclusive of women and women's health as well wonderful it's really important work and

thank you so much for sharing that with us and time permitting i'm hoping to come back to some of that intersection between where you started and individual behavioral change and the impacts you made there compared to what potentially you might make through policy work at a larger population level but now when you're not doing your day job what is it that you like to do um well like we're so in washington dc we're still pretty locked down from the pandemic so any chance i have to get outside i'm very happy to embrace i have a

small dog and like to spend time outdoors with him we're also coming into uh us baseball season so i'm a big baltimore orioles baseball fan and i'm looking forward to the day i get fully vaccinated and can start going to baseball games and i am a actually closer to australia where you are i'm a les mills body pump instructor so they're based out of new zealand and i'm a group fitness instructor as well you got your hands full there how well how off how often do you do the the group instruction and not at all

right now because my gym isn't doing um classes because of the pandemic they're really limited so only doing i think a few outdoor classes but i'm hoping to do maybe more on a substitute basis once we're we're allowed to start doing things more regularly again yeah and again time for meeting hopefully we'll get under baseball i'm a huge red sox fan but let's not go there right now but if you had to describe yourself in five words what would they be i'm organized i think that is a very serious personality trait i'm a bookworm i

i love to read i'm i would say i'm loyal i'm resilient and i'm a feminist wonderful it's wonderful to get to know you a little bit better and i think for the listeners it's very helpful to put the the remainder of the content into the context of where you're coming from and what is really important to you so now this is a really really important topic and something you've published on relatively recently and we'll provide a link to that material in the show notes but the purpose of today really is just to dig into that

a little bit more deeply and as the first part of that really just to set some context can you just describe or summarize some of the sex and gender differences in osteoarthritis yeah and i will preface this with the caveat that i am not the osteoarthritis the oa expert i i'm not trained in that area but like you said we published recently on it and we did that through bringing together a working group of experts so any any mistakes i make when i'm talking to you today are solely my own and not these experts who

are really wonderful folks doing amazing research in that area but we brought them together for a panel and really what we've learned and kind of what we've published is oa is a hugely impactful disease i think more than 300 million people globally and we really do see a higher prevalence in women especially after they hit age 50 or so than in men so there's you know i think both gender is very affected by this and it's certainly a common condition but affecting more women in those certain age groups and we also see that when folks

are diagnosed with oa it affects them differently so women often demonstrate increased disease severity and increased disability and the reason for these sex and gender differences is really not well understood yet and so that those were some of the things we were looking into that's wonderful now i fully appreciate that it's not particularly well understood why those gender discrepancies are there but can you just elaborate a little bit on some of the theory behind why this might be more common in women than it is in men particularly after the age of menopause yeah so i

think that that is one of the key factors which is that age prevalence discrepancy that we see so you know at around the age of 50 which as you noted is around the age of menopause for women we really start to see these discrepancies and prevalence and incidence rises really sharply among women around age 80 or so those rates kind of level off again and disease rates you know become similar which may be in part due to survivorship bias as women tend to have longer life expectancies but i think underlying all of this is you

know there's hormonal differences between males and females and so we think there's probably a role of hormones of sex hormones in oa there's likely likely some gender issues as well related to risk and risk factors there but we think hormones are a factor we also think maybe muscular or structural differences mechanical differences and men's and women's bodies may play a role but these are i think kind of early theories and we i think we know that these factor into it but it's not yet clear what that's precise pathway is to explain those gender discrepancies yeah

and really just to emphasize a lot of what melissa is saying those theories have been around for a long time and despite the importance of this gender difference between women and men i think a lot of the understanding for those differences hasn't particularly been well explained so there's been a number of studies now looking at estrogen differences estrogen receptor differences in in men and women and even looking at hormone replacement therapy differences and trials in that area as well as the the neuromuscular differences so differences in alignment differences in strength that may account for some

of the mechanical predisposition that women have there but again nothing particularly solid that we can count on that we can say categorically this is why women have more osteoarthritis than men one other thing that you alluded to there in the intro is some of the differences that that women face when they when they seek health care what biases do women face when they go along and see healthcare professionals and and what is normalization of pain and what can be done about it yeah i think the word normalization is a really important one there and this

is this is an issue on a broad global level for sure it's not it's not just away although oa is you know a disease characterized by chronic pain and so that is a particularly stigmatized symptom that we see with women and also with people of color and so when women or when people of color come into the clinic and they have chronic pain often they are treated as though their reaction to their symptoms is dramatic it's hysterical it's exaggerated there's kind of this pervasive bias within our health care system that and frequently not all the

time but you know we kind of tend to believe that men are stoic so when they're complaining of pain it's really serious because we don't often see men complain but women are you know maybe they're whiny or maybe they're dramatic and so they're probably exaggerating their own self-report of their symptoms and when you say normalization it's this tendency for i mean it can happen in a variety of scenarios it's not just the clinical or the health care scenario but you know if a patient is coming in to their health care provider and she's a woman

and she's saying you know i've just had this persistent knee pain that's been going on for a while it's maybe the provider coming back to her and saying well everyone gets knee pain as they get older that's a normal part of life um so you know i think just deal with it for another six months and maybe if it gets worse we can follow up as opposed to taking the complaint seriously and doing more investigation than and there so this this portrayal to patients that symptoms that are outside of their norm are really just regular

and what everyone experiences and i i think there is a tendency for that type of treatment or that type of response to be directed more frequently towards women or towards people of color in our health care system and we might come back again to this when we talk about a little bit later on but i guess specifically when we're thinking about improving that issue of normalization and pain and that some of the disparities that women face when they go along and see a clinician what is it that you think first and foremost we might be

able to start doing in that space to help address those issues i think the education you know specifically when we're thinking about bias towards women in the health care system education that plays a role i i think they're we we've gotten better in this issue you know this isn't the the 1950s where women are were dismissed and sent off to you know a spa for a few days to recover from their physical ailments so education has improved but there's still a long way to go in making sure that not just are we aware these biases

exist but we have an understanding as providers and you know i speak as a clinician myself on this what about my own biases and my own beliefs or maybe misguided or affecting the way i treat my patients and making sure that all clinicians have the ability to kind of do that self-assessment and understand where where they may not be treating patients as thoroughly because they they've been thought taught something that is maybe not strictly in line with the research you know like women tend to exaggerate their symptoms so i i think always education but also

setting up systems in the healthcare structure we live and we work in to ensure that it's harder for providers to skip over things you know i think it gets very difficult when you're only given 15 minutes to see a patient to say well and knee pain or you know some kind of minor chronic pain that's not a big complaint and i've got to get through this because i've got 100 more patients scheduled today and i've got to move fast but can we set up systems in the medical records or systems in our general intake forms

to make sure we're really being thorough with the patients and to support the providers and having that that time and that ability to go more in depth so it's multifactorial as these things often are but we need to be supporting folks through education also through giving them the structure that encourages this type of thorough investigation i think yeah so obviously there are big issues and big fundamental system changes that likely need to occur in order to to address those i'm not as part of that it really seemed like you were directing your comments with regards

education towards health care professionals is there any role here for general education of the community as a whole and i guess particularly the women who are presenting here so that they don't get seen in the light or they don't get perceived in that light yeah i think that's a great point and by no means do i i want to only target providers i think a lot of providers out there are very aware of these issues and so it's it's never just you know one group's burden to take up and try to fix this on their

own i think we you know women as patients and i identify as a woman can make sure we're being assertive in our healthcare appointments i think coming in prepared to appointments prepared and making sure we're educating people just as they as they go through school as they go through general education so they feel like they're literate patients you know they feel prepared for their appointments they feel empowered to talk about their symptoms in an assertive way in a way that you know they can really communicate well with their providers i think there's definitely a role

for us to to help those around us by doing that i think you know medical educators and our medical education system is important and just our general education system making sure everyone in the community knows this is something that we need to all be thoughtful about how we contribute and what our role in this is wonderful that's really really important and valuable information now we've spoken a little bit about normalization of pain and the potential for clinician patient interactions to gloss over some of the important issues that women do face what are the disparities do

women face in accessing appropriate care for osteoarthritis yeah this was an area i really haven't done as much research in before we kind of brought this group together and i thought this was very interesting because there's there's not a ton of research here i think we could do more but there's some very clear evidence that shows up on a cert or on a few issues and so one of those is medical devices so you know orthopedic devices knee replacement devices not just in a way but but across the board are often designed to function in

the male body so you alluded to earlier and we talked a bit about you know muscular and mechanical differences structural differences in the human body and if you're designing a device to work in a the average you know 180 pound man that may not work the same way in a much smaller woman who distributes weight differently or kind of lands on her knees or on her hips differently and so we have seen issues where these medical devices orthopedic devices just don't work quite as well or women report higher frequencies of side effects because we're not

considering female physiology when we're kind of developing and testing and approving these devices so that's one thing that in my job i'm really starting to learn more about in terms of medical devices in a variety of conditions but also one of the things that came out that i learned about in working on this paper was you know we recommend treatments in a different way so there's some evidence suggesting providers recommend surgical interventions for oa at a much greater frequency to men and that's true even though we really see good outcomes across both genders you know

women don't show any worse outcomes to that kind of treatment than men do so it's really something about providers just recommending surgery more frequently to men and women maybe being missed or not having a full picture of what treatments are available to them and then the last thing i would say is broadly and again speaking as a psychologist because this is one of my passion issues you know there's a lot of lifestyle and behavioral treatments out there that for a variety of reasons can be hard for patients to access so one of the the different

forms of treatment i worked with when i was practicing was cognitive behavioral therapy for chronic pain and it's hard for all patients not just women to access that type of treatment because we just don't have enough specialists there's reimbursement issues there's provider education and patient education issues there and i think that's a really under utilized route to kind of multi-factorial care so you can get the physical and the physiological but you can also get the cognitive behavioral and those can work really well together and there is some evidence that women might benefit a little differently

to cbt for chronic pain and so i think that's kind of an underexplored way to to help patients out that we need to do some more work on yeah so again some really really important issues that hopefully in time some of the healthcare systems will be set up to to try to address particularly around obviously device design and making it more gender specific but let's dig a little bit more into some of the reasons why clinicians might gloss over a referral of women to surgery where we know that joint replacement is an important opportunity here

and also let's come back in a second to the importance of cbt and psychological support but what are some of the reasons in the first instance is that part of the normalization we were talking about before is that part of the glossing over the clinicians do why don't they refer them to surgeons as willingly as they do men yeah i don't know that we really have a good thorough answer to that question yet i have not stumbled across you know the ultimate research paper explaining this to me but if i had to take a guess

i would say it's a combination of things i think you nailed it with a normalization i would say if we're assuming women's pain maybe is not as bad as they're saying it is providers probably don't feel like this is serious enough to warrant a surgical intervention that not only would be costly and not only would be intensive but would leave patients you know recovering from multiple weeks i i don't think it's an easy surgery for patients and so if we're assuming that their pain is really minimal then maybe it's just not worth it even to

recommend to them so i think that's part of it but i also think there's probably some issues with just not having the general knowledge that this is a bias we have or something a result of maybe the biases we have that are kind of not things that are at the top of our mind and so if we're not really fully informed on the fact that surgery is something that's really beneficial for women in a lot of cases and we aren't recommending it as frequently we just don't have the knowledge to bring that to top of

mind when we're working with patients yeah no i think they're really important issues and as you say potentially under export at this point in time now we know that psychological and mental health issues are really pervasive amongst the osteoarthritis community in general whether it be depression stress anxiety poor coping catastrophizing or poor self-efficacy and the access that patients have to psychological support i think pretty much irrespective of where you are in the world is often poor and i think that's probably germaine whether you're a woman or a man how do we go about fixing that

like you said it's a huge issue and for any patients with a chronic illness if you you don't understand how to continue to live with a high quality of life in the face of a chronic disease it can feel very you know disempowering you and you feel out of control and that certainly can bring on anxiety depressive symptoms and other sorts of adjustment issues and i've seen that in tons of patients so i think yes first of all just to underscore that that is something that's very common in terms of improving access issues you know

i think we as psychologists probably need to do a better job of plugging our services to the general community to a certain point we tend to i think a psychologist to really just say well we're helping people feel better and that's really good but we don't always although i'm seeing the field get better here you know speak in terms of cost effectiveness and real kind of quantitative numbers that rationalize why we are an important contribution to a hospital or a clinical service you know there are real benefits to quality of life for sure but also

cost of care cost to the patient cost to the system if we can help patients feel you know more in control improve self-efficacy like you said and decrease mood symptoms so i think being able to speak to policy makers and you know folks in charge of the clinical and the health care system is really important and speak to them in a way that resonates i think reimbursement rates here in the us are really not great and there's challenges to psychologists providing care you know in cms there's there's often a lot of rules about who has

to be on site you know can it be a resident or can it be a fellow and does the supervisor have to be in there in the appointment that are limiting in ways that physicians don't have kind of the same limitations there and reimbursement rates can be very low so often it's tough to have a psychologist really integrated in a clinic or in a hospital service and for them to feel like they're able to make the money they need to make to prove their worth to that service and to help keep them on and i

think there's you know we're just not well integrated into services because there's not always a understanding of what that care can look like and how that can really work with you know the medical physicians or the nurses who are working on medications or other sorts of surgical or therapeutic interventions and i think there's work to do just in kind of changing that culture of the system to go from physician-directed treatment or physician-only treatment to really a true integrated care approach and i think that's just kind of a learning curve we're still working to explore oh

well here's hoping both with your passion and the work that you do that we can address some of those issues moving forward i hope so now one of the really important focuses of the uh the work that you've just done was in describing some of the research gaps and unmet needs around sex and gender differences in osteoarthritis can you just tell us a little bit about those yeah we broke these into two broad categories and to avoid you know reciting the whole paper i won't go too much into depth here but i think one of

the big categories was just understanding why oa happens you know what is the ideology and what's the pathogenesis you know what causes oa and what can we do to prevent it and what can we do to stop it so we identified i think several different things in that broad umbrella of a category that we need more research on and many of these are related to sex and gender so you know is oa one unitary disease or is it kind of a collection of related diseases or related processes and you know how is that related to

sex as a biological variable um looking at different types of oa so oa presents very differently in different patients and so can we classify patients into subgroups based on that presentation are based on kind of the the biological processes that are happening in the body and is that related to sex or gender i think things like looking at you know what does healthy joint aging look like in men versus women and how can we distinguish normal patterns from disordered patterns and then some of the things we referred to earlier so the effect of sex hormones

hormone replacement therapy um pain pain experience and pain processes in men versus women so we can really understand all of those so that was one big category the other one was clinical care which i think we've touched on pretty well here but you know how does sex and gender affect quality of life disability functionality for patients who are diagnosed with oa how gender contributes to differences in pain perception and pain experience and how we can personalize treatment you know do men versus women respond differently to different types of treatment things like behavioral therapy and some

of the other treatments we've mentioned and then the biases that we've talked about a bit i think obviously a long way to go there as well thanks for sharing that and you've announced some really really important issues there where is your group planning to take this from here and what are you hoping will happen as a consequence of the work that you've done i think right now we're really in the dissemination stage trying to share this paper with different groups very widely and i've been excited because i think for such a you know this feels

like a very nerdy topic it gets very much into the details of oa research but we've gotten some decent attention in kind of pain research and pain groups you know like this podcast so i think just sharing the message that away like many other health conditions gender and sex matter and they affect your experience when you're diagnosed and they affect outcomes and they affect treatment um so so that's kind of the immediate goal for now but i do think we're hoping to continue on this work um i know we have a science team here at

swhr and so they're kind of taking up that banner now but i think we want to work to build some patient educational materials some awareness materials maybe specifically for women with oa and we've done that in other types of health conditions before you know what what do you need to get diagnosed and what do you need to talk to your doctor and how can you manage your own self-care and quality of life in conjunction with a really good medical routine and normal care situation so those are some directions i think we'll probably start to go

in next wonderful well good luck with that and is there anything else that you want to say about that work before i sort of dig into the next segment of the show no i think it other than that this this was a really interesting area for me to dig into it i think we talk really broadly a lot about chronic pain as it relates to to men versus women and obviously that's a big topic because there's so many issues with chronic pain globally but it i don't think we always dive into kind of the the

detailed discussion there and so i think looking at these different diseases that cause you know just long-term really quality of life and functional impacts for women and men and thinking about how we can start to personalize care and better understand you know why these diseases happen and how we can treat it really is an important thing for us to do to curb chronic pain experiences and help patients out on that bigger level so i'm excited for us to keep working in that area good and i encourage you to pursue it strongly that's really really important

work now one really pet interest of mine is that balance and intersection between individual behavioral change and what clinicians at the coal face can do in interacting with patients versus what they potentially could contribute to at a policy level at a broader population level i'm just wondering about your perceptions having worked in both areas about the ability of policy change to impact healthcare and behaviors as opposed to relying what traditionally we have largely done on individual behavioral change techniques yeah i think that's a great question and i you know as a graduate student as a

trainee i wasn't told a lot about paths for my career outside of academia outside of the clinical world and so this is something i really try to you know preach to every trainee that i meet because i think it's important to understand there's a lot of different careers for clinicians and a lot of different ways to kind of have an impact on the world and on the health care system but for me working on an individual level i like i think i mentioned earlier i did a lot of kind of chronic disease work chronic disease

research trying to help patients manage things like weight gain and weight management chronic cardiovascular disease diabetes from a behavioral perspective and it was hugely gratifying because i think we we do know a lot about how to help patients in that manner and often when working with them one-on-one you could see really positive impactful changes with their diseases being better managed their blood levels looking better their weight going down when that was a factor but then what would happen is when i was doing research you know i'd work with them individually for 16 weeks and then

we'd go away because you have to kind of end the treatment and see what happens once they return to their normal lifestyle and what happened is i was working with patients in rural communities and they didn't have that support once we were gone and so they didn't have sidewalks they didn't have healthy grocery stores they were working two or three jobs to support themselves and they were taking care of kids so they didn't have time to exercise and so what i think frustrated me was that i could do a lot to help patients on the

individual level but once they didn't have that support they struggled again and of course they did because they're just in a system that's not set up to to help them in the way that we want to help them and so that that for me is why i went into policy because i really wanted to be able to work on the systematic issues that i think affect our individual patients but i always tell you know when i'm giving this talk to psychology graduate students for example i always tell them there's a lot of different ways to

have an impact and we need clinicians badly i mean we've got health care workforce issues so we need people to stay in the clinical system but to be aware of how the system impacts their patients and you know we've got these evidence-based methods to treat folks but what challenges are they going to face when they're not in your office anymore and they go home and they try to implement what you're telling them to do um you know i remember i worked with unhomed populations when i was training and a lot of them had diabetes and

if they were at a homeless shelter and they didn't have a fridge for their insulin what were they going to do to manage their disease so i think helping patients problem solve those issues and then also speaking out even if it's just in your hospital or your community and being aware of kind of the local issues is a way of balancing that personal one-on-one individual approach with being considerate of the larger system and the challenges inherent in it yeah really really valuable and hopefully as we gain greater knowledge about the importance of healthy foods access

to environments that facilitate physical activity and think about some of the broader process issues and the challenges that people face out there in society we won't be as i guess siloed in the healthcare system about just fragmenting the short interactions that we otherwise have to change behavior now melissa if you could do anything to improve health and healthcare what would you do well i would say from the women's health perspective we need to make sure we understand and we're giving equal awareness to conditions that affect women more than men and this matters from the ground

up because what we see is disorders that predominantly impact women you know things like endometriosis or uterine fibroids or autoimmune disorders or migraine really aren't given the attention research funding in patient awareness and education and that comes out i think in patient outcomes down the line you know a lot of these disorders take longer to diagnose there's confusion in terms of treatment patients aren't even sure where to go and general providers maybe don't have the knowledge or the education to give the nuanced care that a specialty provider might but most women are just going to

you know their primary providers or their ob gyns and so i think putting conditions that that are less less we're less attentive to a kind of at the equal level of you know some of these bigger diseases like cancer or diabetes that kind of affect both genders equally is going to be really important to improving women's health care i know you said i can only do one but i think for my personal approach making sure care is accessible and affordable for everyone is is something that we all really need to work on for sure yeah

and that's obviously been a huge political issue over there and hopefully something that continues to be at front of people's consciousness as they improve their health care system why do you do what you do what motivates you i i think a couple of things you know in my current job i love to learn you know i i don't think you go to graduate school and you get your phd unless you're really really comfortable just continuing to read and to learn and to to be challenged in new ways and i love my current job because i

am just exposed to so many different types of smart people and smart patients who tell me about things i've never heard of and you know how i can continue to improve things in a variety of different ways i think you know i've been a clinician and i've been a patient too in our health care system and i've seen some of this stuff firsthand i've seen how challenging it is to be a patient as a woman i've seen how challenging it is to provide good care as a provider in the system we have and you know

i've also seen from the policy advocacy perspective how challenging it is to change things and i think there's a real need for people to be in this role and to be a policy advocate and that's really important to me you know we were talking about the individual perspective versus the the systematic perspective just a few minutes ago and i i think having people in policy positions who have a scientific research clinical background is really important because we need folks who have been on the ground to make sure the policy works for the patients that it's

going to impact down the road and so for me being able to provide that perspective is also really significant well i hope you maintain the passion and continue to do the great work that you're doing now if you could have a billboard with anything on us what would it be and why i think i would want to put on a billboard that women's health is more than reproductive health in my discussions with all sorts of stakeholders you know the federal agencies policy makers patients the public women's health is a lot of things but we often

talk about it as though it's just pregnancy and conception and you know maternal health care which not to be confused those are hugely important issues and we have a lot of problems with those here in the u.s so i think that that is an important part of health care but we often have tunnel vision and defined women's health as only you know pregnancy or planning for pregnancy or post pregnancy care and you know this oa paper is a really good example women's health is osteoarthritis it's chronic pain it's any sort of disorder a woman can

be diagnosed with there are certain sex and gender factors that we need to consider and so opening up that conversation more broadly and helping people understand that women's health doesn't just mean pregnancy is is a really big thing for me and that's the message i'd want to share well i hope it gets out there and in closing is there any one piece of advice knowledge or wisdom that you'd like to give to people out there who have osteoarthritis yeah i i think the most important thing is to for women specifically but for all patients um

to be assertive with your care and i think we we say this for a lot of different conditions that impact women because because these problems are the same in many ways across diagnoses but you know trust yourself and if the symptoms you're having feel abnormal to you they probably are and if your provider seems rushed or maybe isn't taking you seriously try to try to help them do that try to explain it in a way that you feel like they can understand and if they're not understanding i i think you you find a provider that

does um take an advocate with you a family member or a friend to your appointments because sometimes it can be hard for us to take things in in a really quick amount of time or to communicate in just the 15 minutes and you know do what you need to do to feel like you have your own support system so you can come into your health care appointments feeling educated and empowered and like you're a team member in your care i i think the patient should feel like they they understand their condition and they have a

good relationship with their provider and they understand why they're getting the treatment they're receiving and so the more you can do to to feel like you have a say in that relationship and you're clicking with the provider you're talking to i think is really important really really valuable advice now mother said thank you so much for your time your insights your wisdom and i really hope you continue pursuing this really really important area it's so so important for the community that's out there yeah thank you so much for for giving me the time to talk

about this i really enjoyed the conversation it's our pleasure and hopefully we get a chance to chat again about it soon definitely i hope you've enjoyed today's conversation and found that useful potentially that relates to some of your experience in dealing with this disease but despite the prevalence of osteoarthritis there are foundational gaps in research and understanding of the disease's development and progression long-term studies that bolster existing research and explore the areas that we've outlined in the course of today's conversation are crucial to filling these gaps in knowledge and elucidating sex and gender differences in

osteoarthritis thanks for listening to joint action with david hunter if you like our show and want to know more check out www.jointaction.info if you have any questions you can email us at hello at jointaction.info and follow us on twitter at joint action org this podcast was hosted by david hunter edited by vickie duong music produced by jordan hunter the information posted on this podcast is not intended to diagnose treat cure or prevent disease anyone seeking medical advice should consult a health professional [Music] you