Females With Psoriatic Arthritis, Psoriasis Report Higher Disease Burden

Although psoriasis is more present in male patients, it is linked to worse impact in females, with specific emphasis on the patient global assessment (PtGA). Additionally, female patients with psoriatic arthritis (PsA) were more likely to experience worse function, more disease activity, and a higher disease burden, according to a study published in Rheumatology and Therapy.¹

Ennio Lubrano, MD

Credit: ResearchGate.net

Disease remission or low disease activity have been suggested as an achievable treatment target for patients with PsA. Previous research has demonstrated differences in response to treatment and the burden of disease between sexes, with a higher disease burden in female patients despite the condition being considered equally prevalent among men and women.²

“Previous studies focused on differences between males and females in PsA, in terms of disease activity, functional impairment, and/or response to treatment,” wrote Ennio Lubrano, MD, professor of rheumatology at the Department of Medicine and Health Sciences “Vincenzo Tiberio” and head of the Internal Medicine and Rheumatology Unit, University of Molise, Campobasso, Italy, and colleagues. “However, to the best of our knowledge, few studies have investigated the differences in psoriasis and its impact on disease burden between sexes in PsA patients.”

The cross-sectional analysis of 2 longitudinal PsA cohorts evaluated differences in PsA between sexes, including the impact on disease burden and psoriasis on the t. Patients were divided into early onset psoriasis (EOP), defined as <40 years, and late onset psoriasis (LOP), defined as ≥40 years. They were stratified based on the body surface area (BSA) and the median PtGA was compared between the 4 groups of patients. Any associations between PtGA and skin involvement between sexes were determined using a multivariate linear regression analysis.

Eligible patients were aged ≥18 years, had a PsA diagnosis defined by the ClASification criteria for Psoriatic Arthritis (CASPAR), and were receiving stable treatment with a conventional synthetic disease-modifying antirheumatic drug (csDMARD) or biologic DMARD (bDMARD) for ≥6 months. Additional data collected included a physical examination, laboratory assessment, clinical assessment, medical history, current medications, demographics, disease characteristics, disease duration, and the psoriasis onset age.

In total, 141 males and 131 females were evaluated. The tender and swollen joint count, Health Assessment Questionnaire-Disability Index (HAQ-DI), Psoriatic Arthritis Impact of Disease 12-item (PsAID-12), and Disease Activity Score for Psoriatic Arthritis (DAPSA) were statistically significant in female patients (P ≤.05). Additionally, they reported higher mean pain (5 [± 2.78] vs 4 [± 2.60], P = .003) and worse mean PtGA (5.01 [± 2.51] vs 3.99 [± 2.45], P <.001).

The Patient Acceptable Symptom State (PASS) “yes” was reported more in male patients when compared with female patients (69.5% vs 47%, respectively). The BSA was also higher in males (69.5% vs 47%, respectively). However, minimal disease activity (MDA) was more present in males when compared with females.

Mean BSA was higher in males when compared with females (2.16 [± 3.74] vs 1.22 [± 2.26], P = .015). Female patients with a BSA >0 reported a higher PtGA when compared with males with a BSA >0 (P = .038). No statistically significant association between skin involvement and PtGA was observed at linear regression analysis, despite trending towards female (P = .074). No differences between males and females with a BSA = 0 were observed regarding median PtGA.

“A future research agenda on these differences between the 2 sexes should be addressed, including this topic on larger population studies,” investigators concluded.

References

1. ^{Lubrano E, Scriffignano S, Fatica M, et al. Psoriatic Arthritis in Males and Females: Differences and Similarities. Rheumatol Ther. 2023;10(3):589-599. doi:10.1007/s40744-023-00535-3}
2. ^{Duruöz MT, Gezer HH, Nas K, et al. Gender-related differences in disease activity and clinical features in patients with peripheral psoriatic arthritis: a multi-center study. Joint Bone Spine. 2021;88: 105177}