Spondyloarthritis in women: differences in disease onset, clinical presentation, and Bath Ankylosing Spondylitis Disease Activity and Functional indices (BASDAI and BASFI) between men and women with spondyloarthritides

Abstract

The aim of this study is to assess the gender differences in spondyloarthritides (SpAs) in terms of disease onset, clinical presentation, and the Bath Ankylosing Spondylitis Disease Activity and Functional indices (BASDAI and BASFI). We analysed data from a predominantly female cohort. Five hundred and 16 patients (male:female = 172:344) with SpA who were assessed at our clinic were asked to complete a questionnaire addressing data related to their disease onset (first symptom at presentation, age at which the first symptom presented, age of diagnosis, and delay in diagnosis), clinical presentation (main problem the disease caused them, night pain/sleep disturbance, well-being over the past week, and well-being over the previous 6 months), disease activity indices (erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and BASDAI), and functional index (BASFI). Compared with men, women had greater age at presentation, longer disease duration, more delayed diagnoses and greater age at diagnosis. Back pain was the main presenting symptom equally distributed for both genders. Women had more neck, knee and hip pain as presenting symptoms, while men experienced more feet pain. Back pain is also the main problem that the disease is causing to both sexes. More women had lower back pain, fatigue, neck pain, and pain with pressure as the main problems caused by the disease, while men had more joint pains. Women had significantly greater night pain and sleep disturbance than men. Furthermore, they experienced a worse well-being over past week and over past 6 months in addition to a higher mean ESR (P < 0.005), CRP (NS), BASDAI (P < 0.005) and BASFI (P < 0.05) scores. With regard to the items of the BASDAI index, it displays that women experienced significantly more fatigue (BASDAI 1; P < 0.001), total back pain (BASDAI 2; P < 0.05), and longer duration of morning stiffness (BASDAI 6; P = 0.09). With regard to the items of the BASFI index, women showed greater difficulty in reaching high shelves (BASFI 3; P < 0.001), getting up from the floor when lying on their back (BASFI 5; P < 0.001), and looking over their shoulders (BASFI 8; P < 0.05). SpAs present and progress differently in men and women. Women have more neck, knee, and hip pain at presentation and their main problems arise from the neck, back (lower and upper), fatigue and enthesitis during the course of the disease, whilst in men, feet pain was reported more often as presenting symptom than in women, with joint pain being the main problem caused by the disease.

Understanding How the Diagnostic Delay of Spondyloarthritis Differs Between Women and Men: A Systematic Review and Metaanalysis

“…Delay in diagnosis of SpA has been described in women 5,9,10 and in both sexes 6,7,[11][12][13][14][15][16]20,26,27,29,30,32,33,35,38,39,40,44,45,46 , and although Bandinelli 23 observed less diagnostic delay in women than in men, in most of the papers where delay was compared between men and women, it was greater in women 8,17,18,19,21,22,28,31,34,37,41,42,43,47,48 . This implies that patients have had medically unsolved disorders for a long time, have continued searching for a diagnosis and treatment, or are being erroneously diagnosed and managed 49 .…”

“…Table 1 shows the main characteristics of the 42 studies on diagnostic delay in SpA included in this systematic review 1,2,3,[8][9][10][11][12][13][14][15][16][17][18]19,20,21,22,23,[26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47]48 . The review included 23,883 patients (67.6% men, 32.3% women).…”

“…Regarding juvenile arthritis, we offer data together with adult onset; although there are some papers that include juvenile onset, only 6 of them 6,22,30,39,40,44 offer diagnostic delay disaggregated between juvenile and adult onset of disease. About excluding patients with PsA, there is 1 study 37 in this review in which some patients in the sample may have this disease.…”

Gender characterization in a large series of Brazilian patients with spondyloarthritis

“…Initially considered a C. Campanholo Santa Casa de São Paulo, São Paulo, SP, Brazil disease primarily of the male gender, the profile has changed over time and SpA has been recognized as an important cause of disability among females as well [3][4][5][6][7]. However, a number of discrepancies exist with regard to the clinical manifestations of the disease and there is a need to determine the particularities and severity of SpA in the female gender [3]. As AS has always held a prominent position as a prototype of SpA, most descriptions in the literature refer to the axial form, which hampers further comparative analysis [4][5][6][7].…”

Adaptação cultural cruzada e validação da versão do Índice Funcional de Espondilite Anquilosante de Bath (BASFI) para o português do Brasil

“…11,19 The clinical characteristics of our patients and disease severity were similar. Our patients have longer disease than Spanish group (11 ± 7.8) and also the United Kingdom group (9.9 ± 9.8).…”