Higher Disease Burden Seen in Women With Axial Spondyloarthritis

Women with axial spondyloarthritis (axSpA) had more peripheral manifestations and a higher overall disease burden when compared with men, according to a study published in The Journal of Rheumatology.¹

“Limited information is available on the overall disease burden of axSpA in women, particularly in the US. 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),” investigators explained. “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.”

Between March 2013 and November 2018, this large, independent, prospective, observational study enrolled patients aged ≥ 18 years with axSpA who were not concurrently diagnosed with PsA using data from the Corrona Psoriatic Arthritis/Spondyloarthritis (PsA/SpA) Registry. An axSpA diagnosis was defined using the Assessment of Spondylo-Arthritis international Society (ASAS).

Data was reported using questionnaires from both patients and their rheumatologists, which assessed clinical characteristics, disease activity, comorbidities, treatment history, laboratory data, and patient-reported outcome (PRO) measures. The Ankylosing Spondylitis Disease Activity Score (ASDAS), Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), enthesitis, dactylitis, physician global assessment, and spinal mobility determined disease activity. Information regarding patient-reported pain and fatigue (VAS 0-100), Health Assessment Questionnaire for the Spondyloarthropathies (HAQ-S; 0-3), and EuroQol VAS (EQ VAS; 0-100) was collected. Patients also completed a Work Productivity and Activity Impairment questionnaire.

Characteristics were compared between men and women with axSpA and then further compared between men and women with AS and men and women with non-radiographic axSpA (nr-axSpA).

Of 498 patients with axSpA, 61.6% (n = 307) were male and 38.4% (n = 191) were female. A total of 414 patients had AS and 90 patients had a nr-axSpA diagnosis.

Women scored worse in BASDAI, BASFI, tender/swollen joint counts, enthesitis scores, and the physician global assessment. ASDAS was slightly higher in women and they reported higher inflammatory back pain (IBP) severity in Question 2 of the BASDAI. A higher percentage of women had enthesitis when compared with men (37.2% vs 20.2%; P < 0.01) and a higher erythrocyte sedimentation rate (ESR). They also had worse patient-reported symptoms and scored worse on the Health Assessment Questionnaire for the Spondyloarthropathies.

In women with nr-axSpA, while fewer women had IBP, they reported a greater severity when compared with men.

Women were more likely to have higher overall work and activity impairment when compared with men and were less likely to work full time. Patients with AS had comparable pain scores, however, women with nr-axSpA had worsen pain when compared with men.

Although prior and current biologic use and current conventional synthetic disease-modifying antirheumatic drug (csDMARDs) use were similar in both men and women, women had a higher percentage of prior csDMARDs use (22.0% vs 13.4%, respectively) and they also had a greater number of prior csDMARDs. Prevalence of comorbidities were comparable in both groups, however, more women had depression (25.7% vs 12.1%; P < 0.01) and fibromyalgia (FM; 10.5% vs 1.0%; P < 0.01).

As many patients with axSpA may not be treated by a rheumatologist and patients included in the Corrona Registry are treated by volunteer rheumatologists, the registry may not be representative of all patients with axSpA in the US. Correlation between disease burden and radiographic damage could not be ascertained because radiographic progression data was not collected. Lastly, longitudinal analyses were not conducted due to the cross-sectional design of the study.

“Improved awareness of sex differences in the presentation of axSpA may aid physicians in earlier identification and improved disease management,” investigators concluded. “Further studies are needed to better understand the differences in disease progression and outcomes in men vs women with axSpA.”

Reference:

Mease PJ, McLean RR, Dube B, et al. Comparison of Men and Women With Axial Spondyloarthritis in the US-based Corrona Psoriatic Arthritis/Spondyloarthritis Registry. J Rheumatol. 2021;48(10):1528-1536. doi:10.3899/jrheum.201549