Rheumatic diseases affect a wide range of individuals of all ages, but the most common diseases occur more frequently in women than in men, at ratios of up to ten women to one man. Despite a growing number of studies on sex bias in rheumatic diseases, sex-specific health care is limited and sex specificity is not systematically integrated into treatment regimens. Women and men differ in three major biological points: the number of X chromosomes per cell, the type and quantities of sex hormones present and the ability to be pregnant, all of which have immunological consequences. Could a greater understanding of these differences lead to a new era of personalized sex-specific medicine? This Review focuses on the main genetic and epigenetic mechanisms that have been put forward to explain sex bias in rheumatic diseases, including X chromosome inactivation, sex chromosome aneuploidy and microchimerism. The influence of sex hormones is not discussed in detail in this Review, as it has been well described elsewhere. Understanding the sex-specific factors that contribute to the initiation and progression of rheumatic diseases will enable progress to be made in the diagnosis, treatment and management of all patients with these conditions.

中文翻译：

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风湿性疾病性别偏见的非内分泌机制。

风湿病影响各个年龄段的广泛人群，但最常见的疾病发生在女性身上的频率高于男性，女性与男性的比例高达 10 人。尽管关于风湿性疾病中的性别偏见的研究越来越多，但针对性别的医疗保健是有限的，并且没有将性别特异性系统地整合到治疗方案中。女性和男性在三个主要生物学点上存在差异：每个细胞的 X 染色体数量、存在的性激素的类型和数量以及怀孕的能力，所有这些都会产生免疫学后果。对这些差异有更深入的了解会导致个性化性别特异性医学的新时代吗？本综述重点介绍了为解释风湿性疾病中的性别偏见而提出的主要遗传和表观遗传机制，包括X染色体失活、性染色体非整倍性和微嵌合。本综述未详细讨论性激素的影响，因为它已在其他地方得到很好的描述。了解导致风湿性疾病发生和发展的特定性别因素将有助于在所有患有这些疾病的患者的诊断、治疗和管理方面取得进展。