Sex and gender differences in axial spondyloarthritis: myths and truths

Rusman, Tamara; Bentum, Rianne E. van; Horst-Bruinsma, Irene E van der

doi:10.1093/rheumatology/keaa543

Cited by 70 publications

(84 citation statements)

References 86 publications

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“…Confirming this, Lee et al (2007) demonstrated a more severe radiographic damage among men who showed higher median BASRI−spine scores both in unadjusted and adjusted analyses for age and disease duration. On the other hand, the signs of peripheral involvements such as dactylitis, enthesitis, or swollen joint count appear to be significantly more prevalent in women ( Kennedy et al, 1993 ; Rusman et al, 2020 ). Extra-articular manifestations also appear with a higher rate in female patients ( Landi et al, 2016 ).…”

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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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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“… 29 Most studies have revealed that men are more likely to show worse hip involvement and higher BASRI spine and modified Stoke Ankylosing Spondylitis Spine Score compared with women. 29 …”

Section: Discussionmentioning

confidence: 99%

Trends in amyloidosis in spondyloarthritis: results from the Spanish National Inpatient Registry over a 17-year period (1999–2015)—TREND-EspA study

et al. 2021

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ObjectiveTo assess the incidence of amyloidosis and trends therein in patients with spondyloarthritis (SpA) over a long period (17 years).MethodsAn observational retrospective population-based matched cohort study was conducted. All the admissions of patients with SpA, including ankylosing spondylitis (AS), psoriatic arthritis (PsA), arthritis associated with inflammatory bowel disease (SpA-IBD) and reactive arthritis (ReA), reported between 1999 and 2015, were analysed and a control group matched by age, sex and year of admission was selected. Incidence rates for amyloidosis were calculated. Generalised linear models were used for trend analysis and unconditional logistic regression for calculating crude and adjusted ORs (AOR) to assess the association between amyloidosis and SpA.ResultsThe study database contained data on 107 140 admissions in each group. Between 1999 and 2015, 792 patients in the SpA cohort (0.7% of all admissions) had a diagnosis of amyloidosis versus 68 in the non-SpA cohort (0.1%) (p<0.001). From 1999 to 2015, incidence rates of amyloidosis tended to decrease in the SpA cohort (−4.63%/year overall), while they increased in the Non-SpA cohort (+10.25%/year overall). We found strong associations of amyloidosis with all SpAs (AOR 10.4; 95% CI 8.2 to 13.3) and with each type studied (AORs 10.05 (7.84 to 12. 88) for AS, 9.5 (7.3 to 12.4) for PsA, 22.9 (16.6 to 31.7) for SpA-IBD and 10.1 (6.1 to 16.7) for ReA).ConclusionsIncidence of amyloidosis among patients with SpA has strongly decreased in Spain. Amyloidosis is most strongly associated with SpA-IBD while the strength of association with PsA and ReA is similar to that with AS.

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“…The scoring of the radiographs considered erosions, joint space alterations, and sclerosis. Erosions were graded from 0 to 3 (grade 0, no erosions; grade 1, small, isolated erosions [1][2] or a questionable single erosion; grade 2, de nite erosions [3-5; <3 mm] or a larger single erosion [>3 mm]; and grade 3, multiple [>5] or con uent erosions). Each of the four segments was independently assessed for the slice with the maximum number of erosions in both the transverse and coronal views.…”

Section: Ct Scoring Systemmentioning

confidence: 99%

“…Ankylosing spondylitis (AS) is a chronic in ammatory arthritis affecting the sacroiliac joints (SIJs) and the spine, commonly occurring in childbearing age 1 . Although AS was previously believed to predominantly affect men, recent studies have shown that the incidence of AS in women is as high as one in every three women 2 . Pregnancy is a major issue faced by female AS patients of childbearing age.…”

Section: Introductionmentioning

confidence: 98%

Computed tomography-based assessment of radiographic progression in spine and sacroiliac joints after pregnancy in women with ankylosing spondylitis

Lee

Kim

et al. 2021

Preprint

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We aimed to investigate whether pregnancy affects radiographic progression in patients with ankylosing spondylitis (AS) based on computed tomography (CT) evaluations. This retrospective study included women with AS aged 19–49 years who underwent at least two CT evaluations of the whole spine or sacroiliac joints (SIJs) at intervals of 2–4 years. The delivery group was restricted to women who had the first CT ~ 2 years before delivery and the second CT ~ 2 years after delivery. The CT Syndesmophyte Score (CTSS) (0-522) and SIJ scores (0–40) were used to radiographic progression. A total of 21 women in the delivery group and 38 women in the controls were included. The median (Q1-Q3) CTSS at baseline in the delivery group and controls was 19 (16–23) and 20 (13.25–27.75), and the median progression was 1 (0–3) and 0 (0–1) during the median 2.9-year follow-up, respectively. The median SIJ score at baseline in the delivery group and controls was 13 (8–22) and 11 (6–22), and the median progression was 1.5 (0–3) and 1 (0–2), respectively. The CTSS and SIJ scores significantly increased in both groups; however, no difference in absolute score changes per time-point was observed. Pregnancy do not affect the radiographic progression in AS.

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Sex and gender differences in axial spondyloarthritis: myths and truths

Cited by 70 publications

References 86 publications

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

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

Trends in amyloidosis in spondyloarthritis: results from the Spanish National Inpatient Registry over a 17-year period (1999–2015)—TREND-EspA study

Computed tomography-based assessment of radiographic progression in spine and sacroiliac joints after pregnancy in women with ankylosing spondylitis

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