Clinical Differences between Men and Women with Psoriatic Arthritis: Relevance of the Analysis of Genes and Polymorphisms in the Major Histocompatibility Complex Region and of the Age at Onset of Psoriasis

Abstract

It has been shown that males with spondyloarthritis tend to suffer from more severe spinal disease while females are more likely to have peripheral joint involvement. Nevertheless, gender-related differences have not been thoroughly explored in psoriatic arthritis (PsA). In PsA, males accumulate more peripheral and axial joint damage compared to women. However, it is not clear whether these findings are secondary to differences in occupational physical activity, hormonal changes, or other factors. The present study analyzed the differences in clinical expression of PsA between men and women. We have also evaluated the possible existence of gender-linked differences in the distribution of genes and polymorphisms within the major histocompatibility complex and whether patients' age at the onset of psoriasis established any differences in these aspects. Women suffered more polyarthritis, greater functional impairment, and a larger number of swollen joints during followup. We appreciated a differential expression of certain MHC genes according to gender and age at onset of psoriasis. Our results point to the need to include patient's age at the onset of psoriasis and gender as key stratification elements in future studies of genetic associations in PsA.

Prevalence of acute and chronic viral seropositivity and characteristics of disease in patients with psoriatic arthritis treated with cyclosporine: a post hoc analysis from a sex point of view on the observational study of infectious events in psoriasis complicated by active psoriatic arthritis

“… 27 , 28 Another recently published article confirmed the greater peripheral involvement in women with PsA (with more frequent polyarthritis) as well as greater physical functional impairment. 29 In our analysis, consistently, a significantly greater number of painful joints as well as greater patients’ assessed activity of PsA were observed in female compared to male patients. On the other hand, slightly higher PASI values were observed in men compared to women at baseline.…”

Therapeutic approaches in psoriasis: a post-hoc analysis of the PSYCHAE study from a gender point of view

“…Concerning clinical presentation of psoriasis, it has been reported in previous works that psoriatic arthritis is more frequent in men than in women, particularly in its axial presentations (14), while females are more likely to have peripheral joint involvement (15). The explanation for these differences is not clear, however these clinical expression trends in men and women with arthritis persisted in a more recently published series, which confirmed the greater peripheral involvement in women with psoriatic arthritis (with more frequent polyarthritis), as well as greater physical functional impairment (16). In our series, conversely, no significant difference was observed in prevalence of psoriatic arthritis in male and female patients.…”

The Epidemiology of Psoriatic Arthritis

“…allowing for more than one manifestation or exclusive classification) but also may reflect different subtypes in different populations, the duration of PsA in the population studied, the duration of psoriasis before PsA onset, or age and gender distribution of the population. 3, 60, 62 Recognizing the patient's disease features at onset and when selecting therapies may be important to understanding disease and treatment outcomes. 63 For example, polyarticular disease has been associated with more erosive disease 64 and dactylitis may not respond as well to traditional oral DMARDs.…”