Gender has ‘important effect’ on prevalence of extra-articular manifestations in axial spondyloarthropathy

Uveitis and inflammatory bowel disease as extra-articular manifestations of axial spondyloarthropathy appear to be more common in women, according to data presented at the ACR Annual Meeting.

“Axial spondyloarthropathy is a chronic, inflammatory condition,” said Gillian Fitzgerald, MD, Rheumatology Specialist Registrar at St. James’s Hospital in Dublin, during a press conference. “Historically, it was thought to be a disease that almost exclusively affected men. It’s now known that women are affected almost as often as men. We were interested in looking at the effects of gender and disease duration on the risk of extra-articular manifestations.”

Fitzgerald and colleagues examined the prevalence of extra-articular manifestations among 564 patients with axial spondyloarthropathy in the Ankylosing Spondylitis Registry of Ireland, which was initiated in 2013 to collect epidemiological data about patients in Ireland with the disease and to establish a registry for future studies. The majority of patients were men (78.2%; n = 441) and the mean age was 47.1 years; mean disease duration was 20.8 years.

Uveitis was seen in 35.5% of patients, making it the most common extra-articular manifestation observed among the cohort. Psoriasis was identified in 17.8% of patients; inflammatory bowel disease was noted in 9.7%. Women were more likely than men to have uveitis (46.7% vs. 32.3%; P = .003) and inflammatory bowel disease (16.5% vs. 7.7%; P = .004).

Regression analysis demonstrated that being a woman and a disease duration of more than 10 years were predictive of uveitis. Being a woman, having an elevated C-reactive protein level at baseline and presence of peptic ulcer disease were predictive of inflammatory bowel disease.

“Gender appeared to have an important effect on the risk of extra-articular manifestations,” Fitzgerald said. “This adds to recent findings that axial SpA affects women almost as frequently as men and gives us important information about the pattern of extra-articular manifestations in women. Not only do they suffer from the same extra-articular manifestations as men, but, in fact, they appear to be at a higher risk of both uveitis and inflammatory bowel disease.”

These findings will benefit all rheumatologists, according to Fitzgerald.

“It is important for [rheumatologists] to tackle all aspects of axial spondyloarthropathy, including associated conditions,” she said. “Some of these conditions can be obvious, such as extensive psoriasis, but others can be quite subtle, such as mild inflammatory bowel disease, where the symptoms can often be attributed to other causes. A lack of knowledge regarding which subsets of patients are more likely to develop these conditions is a key barrier to identifying and treating them. Our findings help bridge this knowledge gap.” – by Julia Ernst, MS

Reference:

Fitzgerald G, et al. Abstract 2751. Presented at: American College of Rheumatology Annual Meeting; Nov. 11-16, 2016; Washington.

Disclosures: Fitzgerald reports no relevant financial disclosures. Please see the full study for a list of all other authors’ disclosures.