Sex-Specific Differences in Patients With Psoriatic Arthritis: A Systematic Review

Abstract

ObjectiveA systematic review of published literature was conducted to collate evidence on sex-specific differences in clinical characteristics, disease activity and patient-reported outcomes (PROs) in psoriatic arthritis (PsA), including response to treatment.MethodsSearches of MEDLINE, Embase and the Cochrane Database of Systematic Reviews were performed in November 2020 for observational studies of adults with PsA reporting outcomes by sex (published 2015–), with hand searches of systematic literature review and (network) meta-analysis bibliographies, plus searches of ClinicalTrials.gov and congress abstracts from the European League Against Rheumatism, American College of Rheumatology and American Academy of Dermatology (2019–2020). Eligible studies pre-specified a comparison by sex and reported clinical characteristics and/or disease activity (N>100). Data extracted included patient characteristics, study design, baseline clinical characteristics, and disease activity results (including PROs).ResultsDatabase searching yielded 3,283 unique records; 31 publications (27 unique studies) were included. The review found generally higher rates of peripheral disease in women, including higher tender joint counts (TJCs). There was some evidence of more axial disease in men, plus greater skin disease burden. There were consistently no differences in Dermatology Life Quality Index scores, though across other PROs women had worse scores, including pain and fatigue. Women had poorer responses to treatment, indicated by outcome measures such as American College of Rheumatology responses and minimal disease activity.ConclusionThis review indicates that important differences exist between the sexes in PsA. However, the limited evidence for this conclusion underlines the need for additional research in this area.

Psoriatic Arthritis in Males and Females: Differences and Similarities

“…The present article showed a worse psoriasis in males when compared to females in two PsA settings. This result has been previously reported [11], confirming that psoriasis could be more frequent in males. However, when evaluating the role of psoriasis in terms of disease burden, we found that psoriasis was a factor potentially influencing the PtGA, reinforcing that PtGA is able to capture differences between males and females when the skin involvement is present.…”

“…Beyond the real possibility to achieve good disease control in PsA patients, evidence suggests a different burden of disease and response to treatment between sexes in patients with spondyloarthritis [7][8][9] and PsA [10][11][12]. Although PsA is considered equal in prevalence between males and females, evidence showed that the burden of the disease is higher in females when compared to males [13,14].…”

“…In particular, psoriasis, as a clinical feature of PsA, seems to be more prevalent in males, but with less impact on disease burden [15,16]. Previous studies focused on differences between males and females in PsA, in terms of disease activity, functional impairment, and/or response to treatment [10][11][12][13][14]. However, to the best of our knowledge, few studies have investigated the differences in psoriasis and its impact on disease burden between sexes in PsA patients.…”

Sex Differences in the Effectiveness of First‐Line Tumor Necrosis Factor Inhibitors in Psoriatic Arthritis: Results From the European Spondyloarthritis Research Collaboration Network

“…Sex differences in the disease manifestation of PsA have been identified. 6,7 Women have significantly more peripheral arthritis and more frequently experience polyarticular involvement, whereas the oligoarticular pattern is more common in men. 8 Furthermore, women may be more prone to enthesitis and have higher tender joint counts, whereas men more commonly have axial involvement, severe psoriasis, and radiographic joint damage.…”

“…8 Furthermore, women may be more prone to enthesitis and have higher tender joint counts, whereas men more commonly have axial involvement, severe psoriasis, and radiographic joint damage. 6,7 Moreover, women frequently report greater pain, functional limitations, depression, and poorer quality of life. 7 Sex differences may also extend to molecular pathways related to disease development; one study suggested that the expression of genetic risk factors associated with disease susceptibility could vary with sex.…”