Women experience higher axial spondyloarthritis disease burden than men
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Women demonstrate higher axial spondyloarthritis disease burden, and more peripheral symptoms, than men, according to data published in The Journal of Clinical Rheumatology.
“Limited information is available on the overall disease burden of [axial spondyloarthritis (axSpA)] in women, particularly in the United States,” Philip J. Mease, MD, of the Swedish Medical Center and the University of Washington, in Seattle, and colleagues wrote. “Women are generally underrepresented in clinical studies and much of the available data on axSpA disease burden in women are derived from patients with [ankylosing spondylitis (AS)].”
“Considering our limited historical understanding of sex differences in axSpA, it is important to better characterize differences in disease presentation between men and women to ensure that women are represented in clinical studies and routine practice,” they added. “A thorough understanding of these differences may lead to improved identification of patients with axSpA and earlier diagnosis.”
To compare characteristics and disease burden between men and women with axial SpA, Mease and colleagues analyzed data from Corrona Psoriatic Arthritis/Spondyloarthritis Registry. Established in March 2013, the Corrona registry is a large, independent, prospective, observational cohort of patients with SpA or PsA from 58 private and academic sites across 30 states, according to the researchers. As of Nov. 1, 2019, the cohort included approximately 4,095 patients with 16,687 visits.
For their own study, Mease and colleagues included all 498 adult patients — 307 men and 191 women — with axial SpA and available sex information enrolled in the Corrona registry between March 2013 and November 2018. Those with concurrent PsA were excluded. The researchers compared patient demographics, clinical characteristics, disease activity, patient-reported symptoms, work productivity and treatment history at enrollment between men and women. Their analysis included t or Wilcoxon rank-sum tests for continuous variables, as well as 2 or Fisher’s exact tests for categorical variables.
According to the researchers, women experienced higher disease activity — based on the Bath Ankylosing Spondylitis Disease Activity Index, the Bath Ankylosing Spondylitis Functional Index and physician global assessment — as well as higher tender/swollen joint counts and enthesitis scores, compared with men (P .01).
Women also demonstrated worse patient-reported symptoms — including pain, fatigue, Health Assessment Questionnaire for the Spondyloarthropaties and EuroQol Visual Analogue Scale (P < .05) — as well as greater work and activity impairment. Women were also less likely to work full-time than men.
In addition, prior conventional synthetic disease-modifying antirheumatic drug and prednisone use was more common in women compared with men (P < .05); women were also more likely to have diagnoses of depression and fibromyalgia (P < .01).
“This real-world study of patients with axSpA enrolled in the Corrona PsA/SpA Registry is one of the first to evaluate differences in clinical and patient-reported disease burden between men and women with axSpA in the United States,” Mease and colleagues wrote. “Women had greater overall disease burden compared with men, including higher disease activity, worse patient-reported symptoms, and greater work productivity impairment. We observed similar results when patients were stratified by diagnosis of AS or nr-axSpA.”
“Women demonstrated less impairment of spinal mobility but increased signs of peripheral arthritis, suggesting that conventional definitions of axSpA centered around axial symptoms may need to be broadened to include peripheral manifestations in women,” they added. “A substantial delay in diagnosis was observed in both men and women; greater awareness of peripheral axSpA symptoms may reduce delayed or missed diagnoses. Improved awareness of sex differences in the presentation of axSpA may aid physicians in earlier identification and improved disease management.”
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