Women with axial SpA face delayed diagnosis, worse disease burden vs men
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Key takeaways:
- Women with axial SpA have an average diagnostic delay 2.4 years longer than men.
- Women reported higher disease activity, greater functional limitation and worse mental health.
Women with axial spondyloarthritis face longer diagnostic delays and greater disease burden than men despite higher rates of treatment and healthy behaviors, according to data published in International Journal of Rheumatic Diseases.
“Although [axial SpA (axSpA)] can affect both males and females, there are differences in gender in terms of prevalence, clinical presentation, disease characteristics and response to treatment,” Victoria Navarro-Compán, MD, MSc, PhD, of Hospital Universitario La Paz, in Spain, and colleagues wrote. “... Females often experience longer delayed diagnosis or an underestimation of their symptoms due to the erroneous historical assumption that the disease mainly affects males.
“There is some evidence to suggest that females may have a worse efficacy and response to treatments with biologic therapies than males, although this remains to be explored due to the scarcity of studies evaluating this,” they added.
To examine global gender differences in axial SpA, Navarro-Compán and colleagues analyzed cross-sectional survey data from the International Map of Axial Spondyloarthritis (IMAS) study. The study included 5,555 adults with axial SpA, 55.4% of whom were women.
Of all participants, 3,492 were from Europe, 769 were from North America, 600 were from Asia, 548 were from Latin America and 146 were from Africa. The researchers assessed relationships between gender and various aspects of the disease, including patient-reported outcomes and treatments used, using Mann-Whitney tests.
According to the researchers, women demonstrated an average diagnostic delay of 8.5 years (standard deviation [SD]: 9.7), which was 2.4 years longer than the average delay experienced by men (P < .001). HLA-B27 positivity was less likely in women, appearing among 65.8% of women vs. 78.9% of men (P < .001).
Meanwhile, women demonstrated higher disease activity, with an average score on the Bath Ankylosing Spondylitis Disease Activity Index of 5.7 (SD: 2) vs. 5 (SD: 2.2) among men (P < .001). In particular, women reported higher levels of fatigue (6.3 vs. 5.4; P < .001); neck, back or hip pain (6 vs. 5.4; P < .001); and functional limitation (21.2 vs. 18.1; P < .001).
However, women also reported healthier behaviors than men, with lower proportions of smoking (19.7% vs. 23.3%; P = .002) and alcohol consumption (26.7% vs. 33.8%; P < .001).
At the same time, women reported worse mental health on the 12-point General Health Questionnaire (5.1 vs. 4.2; P < .001) and a higher rate of sleep disorders (41.4% vs. 30.3%; P < .001), anxiety (39.2% vs. 27%; P < .001) and depression (34.4% vs. 26.8%; P < .001).
Compared with men, women were more commonly treated with NSAIDs (81.2% vs. 75.5%; P < .001), conventional synthetic disease-modifying antirheumatic drugs (45.5% vs. 41.3%; P = .003) and biologic DMARDs (50.2% vs. 47.1%; P = .03).
“Globally, although females with axSpA reported healthier behaviors and lower frequency of HLA-B27 positivity than males, they had greater diagnostic delay,” Navarro-Compán and colleagues wrote. “Despite receiving medication more frequently, females in this IMAS study had higher disease activity, greater functional limitation and poorer mental health. Although each patient is unique and may have a different experience of the disease, understanding gender-associated characteristics in axSpA is crucial for reducing the disease burden and diagnostic delay in females to improving axSpA care globally.”
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