Understanding differences between men and women with axial spondyloarthritis

Wright, Grace; Kaine, Jeffrey; Deodhar, Atul

doi:10.1016/j.semarthrit.2020.05.005

Cited by 69 publications

(81 citation statements)

References 79 publications

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“…In contrast to the preponderance of data on AS, a single study on the effect of HLA-B27 on the activity of AxSpA concluded, as supported by our data, that HLA-B27 was associated with less disease activity 16 . A potential explanation for this paradox is that AS is more common in men, while AxSpA is more common in women 15 , 21 . Women have been shown to have higher BASDAI scores than men 15 , 21 .…”

Section: Discussionmentioning

confidence: 99%

“…A potential explanation for this paradox is that AS is more common in men, while AxSpA is more common in women 15 , 21 . Women have been shown to have higher BASDAI scores than men 15 , 21 . Further, the survey nature of our study likely contributes by including more women than men since women are known to participate more frequently in surveys compared to men 22 .…”

Section: Discussionmentioning

confidence: 99%

“…Based on our clinical experience with patients’ description of their own diagnosis, we question if respondents reliably distinguished AxSpA or nr-AxSpA from AS. Epidemiologic data indicate that AxSpA is common 15 . Further, subjects were allowed to provide more than one diagnosis such as acute anterior uveitis and AS.…”

Section: Discussionmentioning

confidence: 99%

“…AxSpA differs from AS in several major respects. For example, in contrast to AS, AxSpA is more common in females 14 , 15 . Despite the absence of radiographic changes in the sacroiliac joints of many patients with AxSpA, the disease activity in AxSpA is generally comparable to the disease activity in AS as judged by the BASDAI 14 , 15 .…”

Section: Introductionmentioning

confidence: 95%

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HLA-B27 is associated with reduced disease activity in axial spondyloarthritis

Rosenbaum

Weisman

Hamilton³

et al. 2021

Sci Rep

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HLA-B27 is associated with increased susceptibility and disease activity of ankylosing spondylitis, but the effect of HLA-B27 on the activity of the broader category now called axial spondyloarthritis (AxSpA) is apparently the opposite. A modified Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was used to assess disease activity among 3435 patients with spondyloarthritis (SpA) who participated in a survey designed to assess the effect of their disease and its treatment on the susceptibility and severity of Covid-19. Chi square testing was used to compare BASDAI scores between HLA-B27 positive and negative subjects. 2836 survey respondents were HLA B27 positive. The average BASDAI for the HLA-B27 negative cohort was 4.92 compared to 4.34 for the HLA-B27 positive subjects. Based on linear regression, a subject’s sex could not fully account for the differing BASDAI score in HLA-B27 negative subjects compared to those who are HLA-B27 positive. The difference between B27 positive and negative subjects was skewed by those with a BASDAI score of one or two. HLA-B27 positive subjects were more than twice as likely to have a BASDAI score of 1 compared to HLA B27 negative subjects and about 60% more likely to have a BASDAI score of 2 (p < 0.0001). HLA-B27 positive subjects have less active spondyloarthritis compared to HLA-B27 negative subjects as measured by a BASDAI score. Our data indicate that patients with mild back pain and a diagnosis of AxSpA are disproportionately HLA-B27 positive. The HLA-B27 test facilitates the diagnosis of axial spondyloarthritis such that patients from a community survey with mild back pain may be disproportionately diagnosed as having AxSpA if they are HLA-B27 positive. The test result likely introduces a cognitive bias into medical decision making and could explain our observations.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 95%

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HLA-B27 is associated with reduced disease activity in axial spondyloarthritis

Rosenbaum

Weisman

Hamilton³

et al. 2021

Sci Rep

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“…Studies have reported that women have more peripheral disease and higher pain, fatigue, and disease activity, whereas men have higher inflammatory markers and structural damage on radiography. 4,5 In this issue of The Journal of Rheumatology, Mease, et al report the sex differences in axSpA using real-world data from the Corrona Registry. 6 The Corrona Psoriatic Arthritis and Spondyloarthritis (PsA/SpA) Registry is a large prospective observational cohort started in 2013 from 58 practices across 30 states in the United States.…”

Section: Gender Differences In Disease Activity and Impact In Axial Spondyloarthritismentioning

confidence: 99%

Gender Differences in Disease Activity and Impact in Axial Spondyloarthritis

Leung

2021

J Rheumatol

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Ankylosing spondylitis (AS), characterized by inflammatory back pain and sacroiliitis on radiography, was traditionally considered a condition predominant in men. Since the introduction of the 2009 Assessment in Spondyloarthritis international Society classification criteria1 aiming to facilitate earlier classification of cases without radiographic sacroiliitis, more women have been classified as having axial spondyloarthritis (axSpA).

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Influence of Sex on Early Axial Spondyloarthritis: A Six‐Year Longitudinal Analysis From a Large National Cohort

Aouad

Tournadre

Lucasson

et al. 2023

Arthritis Care & Research

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ObjectiveThe objective was to determine sex differences in disease outcomes in recent axial spondyloarthritis (SpA) over time.MethodsWe analyzed the first 6 years of follow‐up of the prospective French multicenter DESIR cohort. Patients analyzed had <3 years of disease, were naive to disease‐modifying antirheumatic drugs, and fulfilled the Assessment of SpondyloArthritis international Society classification criteria for axial SpA. Disease activity (Ankylosing Spondylitis Disease Activity Score [ASDAS] using the C‐reactive protein [CRP] level), patient global assessment (PtGA), CRP level, and radiographic sacroiliitis were compared between men and women (self‐reported sex) by linear and logistic mixed‐effects models. Models were created for trajectories of disease activity over 6 years in men and women, using k‐means.ResultsOf 494 patients analyzed (mean ± SD age 31.9 ± 7.5 years, symptoms duration 20.7 ± 11.7 months), 50.4% were men. Over 6 years of follow‐up, both men and women showed clear improvements in ASDAS‐CRP, PtGA, and CRP level. Women had higher ASDAS‐CRP and PtGA over time compared to men (both P < 0.0001) with overall similar CRP levels (P = 0.089), whereas structural damage increased more in men (P < 0.0001). One‐third of both men (33%) and women (34%) belonged to persistent high/very high disease activity trajectories, but ASDAS‐CRP was globally higher in women in these trajectories.ConclusionIn early axial SpA, clinical outcomes (disease activity and symptoms) were worse in women than men over 6 years of follow‐up, whereas CRP was similar and structural damage was more frequent in men. Although similarly distributed, disease activity scores were higher in women in high/very high disease activity trajectories. Sex appears to be an important contextual factor in axial SpA.image

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Understanding differences between men and women with axial spondyloarthritis

Cited by 69 publications

References 79 publications

HLA-B27 is associated with reduced disease activity in axial spondyloarthritis

HLA-B27 is associated with reduced disease activity in axial spondyloarthritis

Gender Differences in Disease Activity and Impact in Axial Spondyloarthritis

Influence of Sex on Early Axial Spondyloarthritis: A Six‐Year Longitudinal Analysis From a Large National Cohort

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