The disease burden of axial spondyloarthritis: through a gendered lens

Khan, Sara; Shridharmurthy, Divya; Lapane, Kate L.; Dubé, Catherine; Kay, Jonathan; Yi, Esther; Liu, Shao‐Hsien

doi:10.1007/s10067-021-06008-8

Cited by 6 publications

(5 citation statements)

References 25 publications

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“…Thus, female with axSpA were older, presented less HLA-B27 positivity, had more peripheral manifestations and more fibromyalgia, which is aligned with previous studies 10 22. On the other hand, while a recent meta-analysis showed that the diagnostic delay in axSpA is longer for females compared with males (8.8 vs 6.5 years),23–25 our analysis only observed a short difference (6.2 vs 5.6 years), which was not statistically significant. Relating to pSpA and gender differences, previous data were very scarce, and limited to non-adjusted comparisons 4 26.…”

Section: Discussionsupporting

confidence: 87%

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: Discussionsupporting

confidence: 87%

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

et al. 2022

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Section: Discussionmentioning

confidence: 99%

“…In addition to the inconsistencies in the international guidelines on medications during pregnancy, we also observed that the majority of patients with axSpA did not have rheumatologist visit before and during pregnancy. Lack of a pre-pregnancy visit could result in worsening of axSpA symptoms and avoidance of anti-inflammatory therapy because of concerns about anti-inflammatory drug use during pregnancy 53. As such, coordination of care between rheumatologists, OBs and PCPs is crucial to ensuring optimal pregnancy outcomes in women with rheumatological conditions.…”

Section: Discussionmentioning

confidence: 99%

“…Lack of a pre-pregnancy visit could result in worsening of axSpA symptoms and avoidance of anti-inflammatory therapy because of concerns about anti-inflammatory drug use during pregnancy. 53 As such, coordination of care between rheumatologists, OBs and PCPs is crucial to ensuring optimal pregnancy outcomes in women with rheumatological conditions. Our findings showed that the rate of prescriptions for biologics, non-biological DMARDs, NSAIDs, steroids and opioids was reduced during pregnancy compared with baseline use.…”

Section: Open Accessmentioning

confidence: 99%

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Comanagement with rheumatology and prescription biologics filled during pregnancy in women with rheumatic diseases: a retrospective analysis of US administrative claims data

et al. 2022

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ObjectivesTo evaluate comanagement with rheumatology and biological prescriptions filled during pregnancy among women with axial spondyloarthritis (axSpA), rheumatoid arthritis (RA) or psoriatic arthritis (PsA) and to examine factors associated with receiving comanagement with rheumatology during pregnancy.DesignA retrospective analysis of US claims data.SettingCommercially insured enrollees using data from the 2013–2018 IBM MarketScan Commercial Claims and Encounters Database.ParticipantsWe identified 4131 pregnant women aged ≤55 years from the 2013–2018 IBM MarketScan Commercial Claims and Encounters Database with an International Classification of Disease, 9th Revision/10th Revision codes for RA, axSpA or PsA, with continuous enrolment at ≥3 months before the date of the last menstrual period (LMP) (index date) and throughout pregnancy.Primary outcomesFilled biologics (prescriptions and infusions) claims were categorised by 90 days before the LMP and trimester, as were primary care, obstetrician and rheumatological claims.ResultsThe prevalence of axSpA, RA and PsA was 0.7%, 0.2% and 0.04% among reproductive age women. The average maternal age was 32.7 years (SD 5.7). During pregnancy, 9.1% of those with axSpA (n=2,410) and 56.4% of those with RA/PsA (n=1,721) had a rheumatological claim. Biologics claims were less common among those with axSpA (90 days before LMP: 1.6%, during pregnancy: 1.1%) than those with RA/PsA (90 days before LMP: 11.9%, during pregnancy: 6.9%). Medications during pregnancy included corticosteroids (axSpA: 0.3%, RA/PsA: 2.2%), non-biological disease-modifying antirheumatic drugs (axSpA: 0.2%, RA/PsA: 1.7%), non-steroidal anti-inflammatory drugs (axSpA: 0.2%, RA/PsA: 1.3%) and opioids (axSpA: 0.2%, RA/PsA: 0.6%). Established rheumatological care and biologics claims during the 90 days before LMP showed good prediction accuracy for receiving comanagement with rheumatology during pregnancy (axSpA: area under the receiver operator curve (AUC) 0.73, RA/PsA: AUC 0.70).ConclusionComanagement with rheumatology during pregnancy occurs infrequently, especially for women with axSpA. Biologics claims during pregnancy may not align with published guidelines. Future research is warranted to improve comanagement with rheumatology during pregnancy.

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“…The fact that younger patients were associated with a higher healthcare utilization could be due to the early onset of functional limitations in daily activities among these patients [13]. In this sense, a Dutch study reported that younger patients with Ankylosing Spondylitis (AS) more often withdrew from work than older patients [14].…”

Section: Socio-demographic Factors and Healthcare Utilizationmentioning

confidence: 99%

Patients with Axial Spondyloarthritis are Great Consumers of Healthcare Resources, Especially Young and Women: Results from the Spanish Atlas

et al. 2023

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Introduction: This study aimed to assess high healthcare utilization over 1 year in patients with axial spondyloarthritis (axSpA)and factors associated with increased healthcare utilization. Methods: A total of 530 unselected patients with axSpA from the Atlas of Axial Spondyloarthritis in Spain-who had used at least one healthcare resource-were included in the present study. Total health care utilization was obtained from the total number of healthcare visits, medical tests, hospital admissions and emergency visits, during the 12 months prior to the survey. Linear regression was used to analyse possible factors associated with higher healthcare utilization. Results: A total of 530 patients with axSpA participated in this study: mean age was 45.3 years and 51.1% were female. In the previous 12 months, 77.9% (n = 530) used at least one healthcare resource, with the median healthcare utilization at 25. In the multiple linear regression, the only categorical factor associated with higher healthcare utilization was female gender (b = 12.854), while the continuous factors associated with higher healthcare utilization were higher disease activity (b = 3.378), longer diagnostic delay (b = 0.959), younger age (b = -0.737) and greater functional limitation (b = 0.576).

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The disease burden of axial spondyloarthritis: through a gendered lens

Cited by 6 publications

References 25 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

Comanagement with rheumatology and prescription biologics filled during pregnancy in women with rheumatic diseases: a retrospective analysis of US administrative claims data

Patients with Axial Spondyloarthritis are Great Consumers of Healthcare Resources, Especially Young and Women: Results from the Spanish Atlas

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