Are we treating women patients with real axial spondyloarthritis?

Nieto, Romina; Rodríguez, Chamaida Plasencia; López, Diana Peiteado; Yllan, A. Villalba; Criado, Alejandro; Navarro-Compán, Victoria

doi:10.1016/j.semarthrit.2019.11.011

Cited by 5 publications

(15 citation statements)

References 11 publications

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“…Initially, we identified 3660 records, 2 of them manually retrieved; among them, 136 full-text articles were evaluated for inclusion, and finally, 41 studies were included. 14,15, Figure 2 shows the selection process. The reasons for excluding 95 articles evaluated in full text are detailed in Supplementary Data 2 (available with the online version of this article).…”

Section: Resultsmentioning

confidence: 99%

“…Of the 41 included studies, all offered BASDAI by sex and only 16 of them offered ASDAS by sex. 14,15,24,25,31,35,36,42,43,49,50,52,53,56,61,62 The total sample was 19,714 patients, with 6785 women (34.4%) and 12,929 men (65.6%). Nearly all the studies (n = 38, 92.7%) were published in or after 2010, with 26 of them (63.4%) in or after 2015.…”

Section: Resultsmentioning

confidence: 99%

“…12 However, 2 recently published papers diverge from the rest of the published literature, detecting differences between sexes in ASDAS, although one of them concluded that their sample was relatively small and it was not possible to carry out the stratified sex analysis for nonradiographic axSpA. 14 The second paper, with no limitations described, showed that male and female patients with very high disease activity have differences in ASDAS at baseline, 15 but as the ASDAS items were not described, we cannot identify which ASDAS components influence the sex differences.…”

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confidence: 99%

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Reviewing Disease Activity Indices in Spondyloarthritis From the Sex Perspective: A Systematic Review and Metaanalysis

et al. 2021

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Objective To determine whether the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Ankylosing Spondylitis Disease Activity Score (ASDAS) exhibited differences between women and men. Methods We systematically searched MEDLINE, Embase, Web of Science and other sources in English or Spanish from 01 January 1995 to 31 July 2020, to assess the differences according to sex in BASDAI and ASDAS. We performed a comparative analysis by sex using t-student test and mean difference by sex meta-analyses for BASDAI and ASDAS, using a random-effects model via the inverse-variance method. Results Forty-one studies included BASDAI (6,785 women/12,929 men) and 16 of them included ASDAS (2,046 women/4,403 men). Disease activity detected through BASDAI was significantly higher in women than in men (mean: 4.9 vs. 4.2, p=0.02), whereas ASDAS did not detect differences between sexes (mean: 2.8 women vs. 2.8 men). In the meta-analyses, BASDAI detected significant differences between women and men [mean difference= 0.55 (95% confidence intervals (95%CI): 0.46, 0.65), p<0.00001], but ASDAS did not identify significant mean difference between sexes [0.04 (95%CI: -0.05, 0.12), p=0.38]. Conclusion The two most widely used indexes of disease activity in spondyloarthritis discriminate differently according to sex by their different evaluation of peripheral disease. Their different components and weights influence BASDAI and ASDAS values. BASDAI may be influenced by fatigue, but in predominantly peripheral manifestations like enthesitis, ASDAS may not be sensitive enough to detect activity. This may represent a gender bias unfavourable to women, because peripheral spondyloarthritis is more common in women than in men.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

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Reviewing Disease Activity Indices in Spondyloarthritis From the Sex Perspective: A Systematic Review and Metaanalysis

et al. 2021

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“…Some limitations of our current analyses have to be acknowledged. Concern has arisen that since the introduction of the ASAS axSpA classification criteria misclassification or overtreatment might occur more frequently, particularly in nr-axSpA [34,35]. There is increasing evidence that several imaging abnormalities might mimic mild sacroiliitis on MRI and some of these are more frequent in women (such as bone more edema following pregnancy or associated with osteitis condensans ilii) [36][37][38].…”

Section: Discussionmentioning

confidence: 99%

Differences between men and women with nonradiographic axial spondyloarthritis: clinical characteristics and treatment effectiveness in a real-life prospective cohort

et al. 2020

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Background Sex differences with regard to clinical manifestations and response to tumor necrosis factor inhibitors (TNFi) have been delineated for the radiographic form of axial spondyloarthritis (axSpA). More limited evidence for a differential effectiveness of treatment in genders exists for the nonradiographic disease state (nr-axSpA). The aim of the study was to compare demographics, clinical parameters, and response to TNFi in women versus men with nr-axSpA. Methods We compared disease characteristics of 264 women and 231 men with nr-axSpA at inclusion in the prospective Swiss Clinical Quality Management Cohort. Response to a first TNFi was assessed in 85 women and 78 men without diagnosed co-morbid fibromyalgia. The primary outcome was the proportion of patients achieving the 40% improvement in the Assessment of SpondyloArthritis international Society criteria (ASAS40) at 1 year. Additional response outcomes were evaluated as secondary outcomes. Patients having discontinued TNFi were considered non-responders. Logistic regression analyses were adjusted for baseline differences, which might potentially mediate the effect of sex on treatment response. Results Compared to men, women had a longer diagnostic delay, a higher level of perceived disease activity, and more enthesitis and were in a lower percentage HLA-B27 positive. An ASAS40 response was achieved by 17% of women and 38% of men (OR 0.34; 95% CI 0.12, 0.93; p = 0.02). A significantly lower response rate in women was confirmed in the adjusted analysis (OR 0.19; 95% CI 0.05, 0.62; p = 0.009) as well as for the other outcomes assessed. Conclusion Despite only few sex differences in patient characteristics in nr-axSpA, response rates to TNFi are significantly lower in women than in men.

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“…Differences in clinical presentation have been noted, with women presenting with more widespread pain, including neck and upper thoracic pain that may not conform to current ‘inflammatory back pain’ definitions [ 15 ] and less radiographic damage, all factors that may contribute to the reported longer diagnostic delay when compared with males [ 16 ]. Overall disease burden is higher in females [ 14 ], although this has not led to an increase in the overall biologic prescription [ 17 ].…”

Section: Prevalence and Gendermentioning

confidence: 99%

Non-radiographic versus radiographic axSpA: what’s in a name?

2020

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Axial spondyloarthritis is a heterogeneous inflammatory condition with variable clinical presentations and outcomes. The complexity of its diagnosis and absence of biomarkers hamper the development of diagnostic criteria with the risk of misuse of the available classification criteria in clinical practice and its consequences. Axial spondyloarthritis should be regarded as a continuum in which some patients, but not all, will have a more severe phenotype characterized by progression into new bone formation and joint fusion. Growing understanding of the factors that might drive disease progression and treatment response will allow for better characterization of treatment options and outcome for each affected individual. The aim of this review is to update the current evidence of what is axial spondyloarthritis and to highlight the need to focus on the concept rather than its classification.

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Are we treating women patients with real axial spondyloarthritis?

Cited by 5 publications

References 11 publications

Reviewing Disease Activity Indices in Spondyloarthritis From the Sex Perspective: A Systematic Review and Metaanalysis

Reviewing Disease Activity Indices in Spondyloarthritis From the Sex Perspective: A Systematic Review and Metaanalysis

Differences between men and women with nonradiographic axial spondyloarthritis: clinical characteristics and treatment effectiveness in a real-life prospective cohort

Non-radiographic versus radiographic axSpA: what’s in a name?

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