Impact of sex on spinal radiographic progression in axial spondyloarthritis: a longitudinal Swiss cohort analysis over a period of 10 years

Abstract

ObjectiveTo investigate sex differences in spinal radiographic progression in axial spondyloarthritis (axSpA).MethodsAxSpA patients in the Swiss Clinical Quality Management cohort with available spinal radiographs every 2 years were included. Paired radiographs were scored by two readers according to the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). Progression was defined as an increase of ≥2 mSASSS units in 2 years. The relationship between sex and progression was investigated with binomial generalised estimating equation models, considering baseline spinal damage as an intermediate covariate. Additional analyses included adjustments for explanatory variables and multiple imputations for missingness.ResultsIn a total of 505 axSpA patients (317 men and 188 women), mean±SD radiographic progression over 2 years was 1.0±2.8 years in men and 0.3±1.1 years in women (p<0.001). Male sex was associated with enhanced progression in a small model not including baseline damage (OR 3.41, 95% CI 1.87 to 6.21). Both a direct effect of male sex on spinal progression, and an indirect effect, via enhancement of baseline spinal damage were significant (OR 2.06, 95% CI 1.15 to 3.67 and OR 1.04, 95% CI 1.01 to 1.07, respectively). A significant impact of male sex on spinal radiographic progression was still demonstrated after multiple adjustments for covariates known to potentially affect spinal radiographic progression (OR 1.97, 95% CI 1.04 to 3.71).ConclusionsSpinal radiographic progression in axSpA is more severe in men than in women, with three times higher odds of progression in male patients and an effect that is mediated in part through an increase in baseline radiographic damage.

Clinical Characteristics of “Severe” Peripheral Psoriatic Arthritis: A Retrospective Analysis of a Longitudinal Cohort

“…This may explain this apparent discrepancy since disease activity scores and outcome measures such as DAPSA and MDA contains “patient-driven” domains such as PtGA and pain that may influence disease activity, but the mCPDAI did not. Our results are in keeping with other studies in axial spondyloarthritis in which male sex is associated with a more severe disease course [ 27 ] and further corroborate the hypothesis that severity and disease activity are different concepts.…”

Sex Bias in Diagnostic Delay: Are Axial Spondyloarthritis and Ankylosing Spondylitis Still Phantom Diseases in Women? A Systematic Review and Meta-Analysis

“…Nevertheless, the ASAS classification criteria might also present some black holes. Firstly, the involvement of the cervical spine seemed higher in women [38], as was also confirmed in a recently published article [27] that showed a slightly higher number of cervical syndesmophytes [27,77] compared to lumbar ankylosis in F, which is a phenomenon that was not observed in men.…”

“…While the severity of well-known aspects of spondylitis, such as sacroiliitis [25,26] and lumbar syndesmophytosis [27], seem more manifest in the M population, the cervical spine's involvement, which is more common in women, is still not included in the classification criteria [27].…”

Early axial spondyloarthritis according to the ASAS consensus definition: characterisation of patients and effectiveness of a first TNF inhibitor in a large observational registry

“… 18 It is also known to be a predictor of treatment response in both radiographical 32 and non-radiographical 33 axSpA and to be associated with accelerated radiographical progression at the levels of the sacroiliac joints 34 and the spine. 35 The impact of sex on treatment response seemed not to be different in early versus established axSpA, as demonstrated by the interaction analyses shown here.…”