Differences Between Women and Men With Recent‐Onset Axial Spondyloarthritis: Results From a Prospective Multicenter French Cohort

Abstract

Objective. To clarify sex differences in early axial spondyloarthritis (SpA). Methods. In total, 475 patients included in the Devenir des Spondylarthropathies Indifférenciées Récentes (Outcome of Recent Undifferentiated Spondylarthropathies) cohort, a prospective multicenter French cohort of patients with early inflammatory back pain suggestive of SpA, and fulfilling the Assessment of SpondyloArthritis international Society (ASAS) classification criteria for axial SpA were studied. The clinical and imaging features were compared between sexes and according to the clinical or imaging arm of the ASAS criteria using univariate and multivariate analysis. Results. Comparisons between the 239 men and 236 women showed that women had higher disease activity when measured by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Patient Global Score and higher fatigue and functional scores despite having less radiographic sacroiliitis and magnetic resonance imaging (MRI) inflammation of sacroiliac joints and the spine than men. Disease activity measured by the C-reactive protein (CRP)-based Ankylosing Spondylitis Disease Activity Score was not different between men and women. In contrast to patients classified with the clinical arm, disease activity and functional scores did not differ between women and men with sacroiliitis on imaging scans, except for fatigue and the Ankylosing Spondylitis Quality of Life questionnaire. Women with sacroiliitis had more peripheral involvement and more family history, whereas HLA-B27 positivity, elevated CRP, and MRI inflammation of the spine were associated with male sex. Conclusion. Women with early axial SpA according to the ASAS criteria had greater disease activity when measured by the BASDAI and worse functioning despite fewer radiologic abnormalities than men. The differences in disease expression may be confounding factors to establish the diagnosis of SpA and to assess disease activity in women, suggesting that the imaging arm is a pivotal measure in the ASAS criteria.

Nonradiographic axial spondyloarthritis background and confounding factors of this new terminology: an appraisal

“…These studies confirm differences in disease expression between men and women in the diagnosis of nr-axSpA [7,21]. Women with early nr-axSpA clearly have greater disease activity despite fewer radiologic abnormalities compared to men.…”

“…Studies question whether coexistent fibromyalgia may be a confounding factor in assessing disease activity and establishing a diagnosis of axSpA in this female patient population [22,23]. Since clinical features of fibromyalgia and SpA overlap, the clinical arm of the ASAS criteria may lead to over-diagnosis of axSpA in women and the lower specificity of the clinical arm (84 %) compared to the imaging arm (97 %) reflects this difficulty [21]. Further research and evaluation of MRI over disease course is needed to clarify this area of interest.…”

“…Conclusions from the study also indicate that female sex is more likely to be associated with nonradiographic disease, lower acute phase reactants, and higher rates of fibromyalgia compared to AS. A further investigation to clarify differences between men and women with axSpA studied a cohort of 475 patients with early inflammatory back pain suggestive of SpA fulfilling the ASAS criteria [21]. Results from this study demonstrate that women have higher disease activity and worse functional impairment according to most scoring methods (BASDAI, BAS-G, BASFI, SF-36 mental and physical scores, HAQ, and ASQoL), higher swollen/tender joint scores, and higher enthesitis scores compared to men.…”

Clinical presentation of patients suffering from recent onset chronic inflammatory back pain suggestive of spondyloarthritis: The DESIR cohort

“…Female gender is associated with higher BASDAI, fatigue and function scores despite less radiographic and MRI modifications than men. Women with radiographic sacro ileitis have more peripheral involvement [28]. Uveitis is associated with cervical involvement, a preceding history of infection and presence of IBD [29].…”

Detection of Crohn Disease in Patients with Spondyloarthropathy: The SpACE Capsule Study

“…Other recent studies have not uniformly confirmed male predominance in SpA. To clarify sex differences, a cohort of 708 patients with early inflammatory back pain suggestive of axSpA was recruited for a prospective multicenter French study 48 . Among the 475 patients diagnosed with SpA, 50.3% were men and 49.7% women.…”