Gender-related differences in axial spondyloarthritis (axSpA) patients

Aim of the work

To explore the gender-related differences in axial spondyloarthritis (axSpA) patients.

Patients and methods

Seventy-six male and 38 female patients with axSpA were assessed regarding disease characteristics and treatment. Disease activity, functional and radiologic severity index were measured using the Bath ankylosing spondylitis disease activity index (BASDAI), Bath ankylosing spondylitis functional index (BASFI), Bath ankylosing spondylitis radiology index (BASRI-s) respectively, and enthesitis was assessed using Maastricht Ankylosing Spondylitis Enthesitis Score (MASES).

Results

The mean age of the patients was 37.8 ± 10 years with a male: female ratio (2:1). Females had more delay in diagnosis (9.2 ± 3.9 years vs males 6.7 ± 3.4 years; p < 0.001) and they had enthesitis, peripheral arthritis, widespread pain and fibromyalgia as initial presentations more often than males. The mean BASDAI and BASFI was higher in females (6.3 ± 1.3 vs 5.2 ± 1.4; p < 0.001 and 6.1 ± 1.4 vs 5.3 ± 1.3; p = 0.003 respectively). Enthesitis increased in females (n = 18, 47% vs n = 12, 15.8%; p < 0.001) with higher MASES than men (3.7 ± 4 vs 1.8 ± 2; p < 0.001).Peripheral arthritis was markedly higher in females (n = 15, 39.5%vs n = 16, 21.1%; p = 0.03).Females more frequently used methotrexate and sulphasalazine (p = 0.003). BASRI-s and sacroiliitis grading were higher in males (7.2 ± 1.9 vs 4.6 ± 1.9; p < 0.001 and 3 ± 0.6 vs 2 ± 0.3; p < 0.001 respectively) with cervical syndesmophyte predominance in females (p = 0.005).

Conclusion

The clinical and initial presentations differ between the two genders and the disease activity, functional limitation, and enthesitis score are higher in females. While radiologic severity is worse in men, there is predominant cervical spine involvement in women.