Patients with axial spondyloarthritis report significant differences between men and women and high impact of the disease: Large websurvey analysis

Ibáñez, Sebastián; Bentum, Rianne E. van; Valenzuela, Omar; Horst‐Bruinsma, Irene E. van der

doi:10.1016/j.jbspin.2020.02.004

Cited by 10 publications

(9 citation statements)

References 15 publications

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“… 37 38 Moreover, previous data suggested that gender-related treatment inequities (leading to females having less access to biologics) might explain higher disease activity in some regions. 39 …”

Section: Discussionmentioning

confidence: 99%

“…Hence, while female gender has been presented as more sensitive to pain and more likely report it, male gender has been portrayed as stoic and more reluctant to express vulnerability or pain 37 38. Moreover, previous data suggested that gender-related treatment inequities (leading to females having less access to biologics) might explain higher disease activity in some regions 39…”

Section: Discussionmentioning

confidence: 99%

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Does gender influence outcome measures similarly in patients with spondyloarthritis? Results from the ASAS-perSpA study

et al. 2022

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ObjectivesTo investigate the influence of gender on disease outcomes in patients with spondyloarthritis (SpA), including across SpA subtypes.MethodsData from 4185 patients of 23 countries with a diagnosis of axial SpA (axSpA), peripheral SpA (pSpA) or psoriatic arthritis (PsA) from the Assessment of SpondyloArthritis International Society (ASAS)-perSpA study were analysed. Associations between gender and disease activity (Ankylosing Spondylitis Disease Activity Score (ASDAS), Bath Ankylosing Spondylitis Disease Activity Score (BASDAI), C-reactive protein (CRP)), function (Bath Ankylosing Spondylitis Functional Index (BASFI)) and overall health (ASAS Health Index (ASAS HI), European Quality of Life Five Dimension (EQ-5D)) outcomes were investigated. Multilevel multivariable linear mixed models adjusted for relevant confounders (and stratified by disease subtype in case of a relevant interaction) were used.ResultsIn total, 65%, 10% and 25% of patients had axSpA, pSpA and PsA, respectively. axSpA was more frequent in males (68%), whereas pSpA and PsA were more frequent in females (53% and 52%, respectively). A significant interaction between gender and disease subtype was found for ASDAS, BASDAI and BASFI. While being female independently contributed to higher BASDAI across the three disease subtypes (with varying magnitude), female gender was only associated with higher ASDAS in pSpA (β (95% CI): 0.36 (0.15 to 0.58)) and PsA (0.25 (0.12 to 0.38)) but not in axSpA (0.016 (−0.07 to 0.11)). No associations were observed between gender and CRP levels. Female gender was associated with higher ASAS HI and EQ-5D, without differences across disease subtype.ConclusionFemale gender is associated with less favourable outcome measures across the SpA spectrum. However, while female gender influences BASDAI across the three subtypes, ASDAS is associated with gender only in pSpA and PsA but not in axSpA. Therefore, ASDAS is an appropriate instrument both for females and males with axSpA.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Does gender influence outcome measures similarly in patients with spondyloarthritis? Results from the ASAS-perSpA study

et al. 2022

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“…Sex differences in QoL and overall well-being were inconsistent, depending on the validated questionnaire used. Significantly worse QoL scores were observed in female patients measured with the Ankylosing Spondylitis Quality of Life questionnaire, the Assessment of SpondyloArthritis international Society (ASAS) Health Index and the BAS-G [ 2 , 3 , 6 , 66 , 82 ]. Other QoL questionnaires, such as the EuroQoL and the 36-item Short Form Health Survey revealed no (large) gender differences [ 1 , 2 , 6 , 79 ].…”

Section: Myth 3: Men With Axspa Have a Worse Disease Outcome Comparedmentioning

confidence: 99%

Sex and gender differences in axial spondyloarthritis: myths and truths

2020

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Mounting evidence reveals evident sex differences in physiology, disease presentation and response to medication in axial SpA (axSpA). Unfortunately these data are often neglected in clinical practice and research. In this review, myths that still exist on diagnosis, disease manifestation and drug effectiveness were argued against data of the most recent literature. The aim is to increase awareness of sex differences in the clinical aspects of axSpA.

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“…At the same time, female patients display less improvement in BASDAI, BASFI, and ASDAS-CRP scores after treatment ( van der Horst-Bruinsma et al, 2013 ; Neuenschwander et al, 2020 ). In addition, women report worse quality of life when the Ankylosing Spondylitis Quality of Life questionnaire (ASQoL) and the Assessment of SpondyloArthritis international Society Health Index (ASA-HI) were used while no gender differences were found using the EuroQoL and the SF-36 Health Survey ( Kennedy et al, 1993 ; Roussou and Sultana, 2011 ; Tournadre et al, 2013 ; Lubrano et al, 2017 ; Ibáñez Vodnizza et al, 2020 ; Neuenschwander et al, 2020 ). In summary, men with ax-SpA present higher objective markers of inflammation associated with radiological progression, although severe ankylosis also occurs in females.…”

Section: Gender Differences In Clinical Phenotypes In Axial Spamentioning

confidence: 99%

Genetics, Epigenetics, and Gender Impact in Axial-Spondyloarthritis Susceptibility: An Update on Genetic Polymorphisms and Their Sex Related Associations

et al. 2021

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Spondyloarthritis (SpA) is a group of chronic inflammatory rheumatic disease that can be divided into predominantly axial or predominantly peripheral involvement, with or without associated psoriasis, inflammatory bowel disease or previous infection. Axial SpA (axSpA) encompasses ankylosing spondylitis (AS) with radiological sacroiliitis, and a type without radiographic sacroiliitis, called “non-radiographic axial SpA” (nr-axSpA). Males and females show large differences in their susceptibility to SpA, such as distinctions in clinical patterns, phenotypes and in therapeutical response, particularly to TNF inhibitors (TNFi). Several studies indicate that AS women have doubled risk to failure TNFi compared with males. This diversity in drugs’ efficacy among women and men may be caused by differences in the balance of sex hormones and in gene-specific expression likely triggered by X-chromosome instability and gene-specific epigenetic modifications. Evidence reported that polymorphisms in microRNAs on X- and other chromosomes, such as miR-146a, miR-155, miR-125a-5p, miR-151a-3p and miR-22-3p, miR-199a-5p could be involved in the different clinical presentation of SpA, as well as disease activity. In addition, association with non−response to TNFi treatment and presence of IRAK3 and CHUCK genes in SpA patients was recently detected. Finally, polymorphisms in genes involved in IL-23/IL-17 pathway, such as in drug pharmacodynamics and pharmacokinetics may have a role in response to TNFi, IL17i, and IL23i. A major understanding of genomic variability could help in the development of new therapeutic targets or in taking advantages of different mechanisms of action of biological drugs. Moving from the multifactorial etiology of disease, the present review aims at evaluating genetic and epigenetic factors and their relationship with sex and bDMARDs response, helping to investigate the different expression among males and females of genes on X- and other chromosomes, as well as mi-RNA, to highlight relationships between sex and occurrence of specific phenotypes and symptoms of the disease. Moreover, the role of the epigenetic modification in relation to immune-regulatory mechanisms will be evaluated.

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Patients with axial spondyloarthritis report significant differences between men and women and high impact of the disease: Large websurvey analysis

Cited by 10 publications

References 15 publications

Does gender influence outcome measures similarly in patients with spondyloarthritis? Results from the ASAS-perSpA study

Does gender influence outcome measures similarly in patients with spondyloarthritis? Results from the ASAS-perSpA study

Sex and gender differences in axial spondyloarthritis: myths and truths

Genetics, Epigenetics, and Gender Impact in Axial-Spondyloarthritis Susceptibility: An Update on Genetic Polymorphisms and Their Sex Related Associations

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