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) years44.1 (12.3)45.5 (13.2)NS
Age at disease onset, median (range) years34.0 (9.1–62.1)38.6 (17.2–75.6)NS
Disease duration, median (range) years4.0 (0.0–46.8)3.0 (0.0–31.1)NS
AS, %46.237.8NS
PsA, %32.318.30.035
USpA, %18.328.0NS
ReA, %3.20.0NS
IBD-SpA, %11.822.0NS
HLA-B27 positive, %47.147.9NS
Inflammatory back pain, %74.281.7NS
Peripheral arthritis, %60.257.3NS
Sacroiliitis low grade, %15.117.1NS
Sacroiliitis high grade, %46.239.0NS
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, %53.370.50.023
ASDAS <1.3 (inactive disease), %23.720.3NS
1.3<= ASDAS <2.1 (moderate disease activity), %32.918.8NS
2.1<= ASDAS<=3.5 (high disease activity), %42.157.8NS
ASDAS >3.5 (very high disease activity), %1.33.1NS
Swollen joint count, median (range) 0–66 joints0 (0–26)0 (0–8)NS
Tender joint count, median (range), 0–66 joints0 (0–34)0 (0–21)NS
Schober, mean (SD) centimetres4.1 (1.3)3.8 (1.0)NS
ESR, median (range) mm/h7 (1–55)14 (2–61)0.001
CRP, median (range) mg/l2.6 (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
DOI:

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