Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
Spondyloarthritis: A Clinical Comparison Between Men and Women.
Paramarta, Jacqueline E., De Rycke, Leen E., Ambarus, Carmen A., Tak, Paul P., Baeten, Dominique L.
Background/Purpose:
Many studies report a male predominance in ankylosing spondylitis (AS), the most prevalent and typical form of spondyloarthritis (SpA). As AS represents only part of the SpA spectrum, an alternative explanation is that the disease has no gender bias but is less typical or severe (including progression towards new bone formation) in females. With the recent treatment advances it becomes increasingly important to recognize also less typical presentations as early as possible in the disease course. The aim of this study was to assess whether gender affects the clinical presentation of SpA in terms of prevalence, symptoms and severity.
Methods:
175 patients presenting on a dedicated SpA outpatient clinic fulfilling the European Spondyloarthropathy Study Group (ESSG) criteria were recruited in a prospective inception cohort. The patient's and physician's global assessment of disease activity visual analogue scale (VAS), Bath Ankylosing Spondylitis Disease Activity (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS), 68 swollen and tender joint count, Schober, ESR and CRP were measured. Parametric tests were used for normally distributed data and non-parametric tests for non-normally distributed data.
Results:
The demographic and clinical characteristics are shown in Table 1. The cohort included 93 men and 82 women, who had a comparable age and disease duration. The prevalence of the SpA subtypes AS, undifferentiated spondyloarthritis (USpA), inflammatory bowel disease related SpA (IBD-SpA) and reactive arthritis (ReA) was not significantly different between men and women. Only psoriatic arthritis (PsA) was significantly more common in men (32% vs. 18%). Classification into axial versus peripheral SpA showed no gender difference as axial disease was more common in both genders. Also HLA-B27 positivity (47% and 48%, respectively) and sacroiliitis on conventional X-ray (61% and 56%, respectively) were similar in males and females. The BASDAI (4.3 in men and 5.3 in women) and ESR (7 mm/h in men and 14 mm/h in women) were slightly but significantly higher in females. The other disease activity parameters were comparable. This trend towards higher disease activity in women was found in all SpA subtypes. Accordingly, anti-TNF therapy was more often initiated in women (39%) than in men (26%) during follow-up.
Table 1. Demographic and clinical characteristics
| Men(n=93) | Women(n=82) | P | |
|---|---|---|---|
| Age, mean (SD) years | 44.1 (12.3) | 45.5 (13.2) | NS |
| Age at disease onset, median (range) years | 34.0 (9.1–62.1) | 38.6 (17.2–75.6) | NS |
| Disease duration, median (range) years | 4.0 (0.0–46.8) | 3.0 (0.0–31.1) | NS |
| AS, % | 46.2 | 37.8 | NS |
| PsA, % | 32.3 | 18.3 | 0.035 |
| USpA, % | 18.3 | 28.0 | NS |
| ReA, % | 3.2 | 0.0 | NS |
| IBD-SpA, % | 11.8 | 22.0 | NS |
| HLA-B27 positive, % | 47.1 | 47.9 | NS |
| Inflammatory back pain, % | 74.2 | 81.7 | NS |
| Peripheral arthritis, % | 60.2 | 57.3 | NS |
| Sacroiliitis low grade, % | 15.1 | 17.1 | NS |
| Sacroiliitis high grade, % | 46.2 | 39.0 | NS |
| Patient's global assessment VAS, median (range) | 48 (0–98) | 57.5 (4–100) | NS |
| Physician's global assessment VAS, median (range) | 38.5 (2–90) | 42.5 (1–81) | NS |
| BASDAI, median (range) | 4.3 (0.0–8.5) | 5.3 (0.4–9.2) | 0.011 |
| BASDAI >=4, % | 53.3 | 70.5 | 0.023 |
| ASDAS <1.3 (inactive disease), % | 23.7 | 20.3 | NS |
| 1.3<= ASDAS <2.1 (moderate disease activity), % | 32.9 | 18.8 | NS |
| 2.1<= ASDAS<=3.5 (high disease activity), % | 42.1 | 57.8 | NS |
| ASDAS >3.5 (very high disease activity), % | 1.3 | 3.1 | NS |
| Swollen joint count, median (range) 0–66 joints | 0 (0–26) | 0 (0–8) | NS |
| Tender joint count, median (range), 0–66 joints | 0 (0–34) | 0 (0–21) | NS |
| Schober, mean (SD) centimetres | 4.1 (1.3) | 3.8 (1.0) | NS |
| ESR, median (range) mm/h | 7 (1–55) | 14 (2–61) | 0.001 |
| CRP, median (range) mg/l | 2.6 (1.0–73.6) | 4.0 (1.0–209.3) | NS |
Conclusion:
Gender does not profoundly affect the clinical presentation of SpA, with exception of a male predominance in the PsA subtype and slightly higher disease activity in females. These data emphasize the need for early diagnosis and adequate treatment of SpA independently of the gender of patients.
To cite this abstract, please use the following information:
Paramarta, Jacqueline E., De Rycke, Leen E., Ambarus, Carmen A., Tak, Paul P., Baeten, Dominique L.; Spondyloarthritis: A Clinical Comparison Between Men and Women. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :521
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