Gender differences among patients with primary ankylosing spondylitis and spondylitis associated with psoriasis and inflammatory bowel disease in an iberoamerican spondyloarthritis cohort

Abstract

The aim of the study was to compare clinical manifestations, disease activity, functional capacity, spinal mobility, and radiological findings between men and women from a multicenter, multiethnic Ibero-American cohort of patients with Spondyloarthritis (SpA).This observational cross-section study included 1264 consecutive SpA patients who fulfilled the modified New York criteria for ankylosing spondylitis (AS). Demographic, clinical, and radiologic data were evaluated. Categorical data were compared by X2 or Fisher's exact tests and continuous variables by ANOVA with post-hoc tests.Primary AS was diagnosed in 1072 patients, psoriatic spondylitis in 147, and spondylitis associated to inflammatory bowel disease (IBD) in 45 patients. Overall, male patients were significantly younger, had longer diagnostic delay, lower disease activity, worse spinal mobility, better quality of life, and more severe radiologic damage. Dactylitis and enthesitis, as well as swollen joint count, were significantly more common among women. In primary AS, there was a marked male predominance (76.2%). Among patients with psoriatic spondylitis, male predominance was lower (57.8%), but was also associated with worse spinal mobility and more severe radiologic damage. In the total population, male patients with primary AS referred higher permanent work disability (13.2% vs 6.9%; P < 0.05), although no difference was observed in psoriatic or IBD spondylitis according to the gender.Among Ibero-American SpA patients, there are some differences in clinical and radiological manifestations, men showing more structural damage, whereas women more active disease. These data suggest that the phenotype of SpA differs between genders. This can influence the subsequent diagnostic approach and therapeutic decisions.

Clinical, Economic, and Humanistic Burden Associated With Delayed Diagnosis of Axial Spondyloarthritis: A Systematic Review

“…The prevalence of AS is approximately 2-to 3-fold higher in men than women [67,68]. Definitive radiographic sacroiliitis and spinal damage occur less frequently in women than men [64,[69][70][71], and women are more likely to have peripheral symptoms [71][72][73][74][75] and extra-articular manifestations [71,[76][77][78]. Thus, early classification criteria that focus primarily on axial symptoms would be less likely to identify female patients with axSpA.…”

Ankylosing Spondylitis in Sub-Saharan Africa: A Series of 48 Cases Reported in Burkina Faso (West Africa)

“…In primary AS, there was a marked male predominance (76.2%). However, Landi found that there are some differences in clinical and radiological manifestations, men showing more structural damage, whereas women more active disease [12].…”

Differences between females and males in axial spondyloarthritis: data from a real-life cross-sectional cohort

“…A major issue is that most studies on gender differences in axSpA used either the modified New York (mNY) criteria for ankylosing spondylitis (AS) or the newer Assessment of SpondyloArthritis international Society (ASAS) criteria for axSpA (2,9,10). Whereas the use of these criteria allows more homogeneous populations to be selected, they heavily rely on the presence of sacroiliitis on imaging and may therefore select a subgroup of female patients that is not completely representative of the patients presenting in daily clinical practice.…”