Does Gender Impact a Diagnosis of Ankylosing Spondylitis?

Abstract

Objective The study objective was to explore differences in ankylosing spondylitis (AS) diagnosis experiences between men and women by examining the coding of health events over the 2 years preceding AS diagnosis. Methods Claims data (January 2006–April 2019) from the MarketScan databases were examined. Patients who had received two or more AS diagnoses at least 30 days apart and had at least 2 years of insurance enrollment before their first AS diagnosis were analyzed. Men were matched 1:1 to women by age, diagnosis date, insurance type, and enrollment duration. Health events (diagnosis and provider codes) were examined over 2 years before AS diagnosis and stratified by gender. Data were analyzed using univariate χ2 tests. Results Among 7744 patients, 274 of 1906 AS‐related codes showed statistically significant differences between men and women. Women received more diagnosis codes than men across diagnoses and providers; the largest difference in diagnosis codes among women versus men was in peripheral symptom coding (57.7% vs. 43.9%, respectively). More women than men received diagnosis codes for depression (21.2% vs. 9.8%) and other musculoskeletal symptoms (52.8% vs. 40.0%); only gout was more common in men (6.5%) than in women (2.2%). Among men, backache codes gradually increased 12 months before AS diagnosis, whereas axial and sacroiliitis coding increased sharply immediately before diagnosis. The greatest difference in physician types visited was for rheumatologists: 64.2% of women had visits compared with 45.1% of men. Conclusion Further investigation into the dissimilarities in diagnostic experiences between men and women is needed to determine whether differences are due to disease phenotype or potential cognitive bias influencing diagnostic decision‐making.

The International Map of Axial Spondyloarthritis Survey: A US Patient Perspective on Diagnosis and Burden of Disease

“…Men and women also experienced differences in the diagnostic journey and management of disease, including differences in health care–seeking behavior, diagnostic coding, and treatment patterns, that may favor earlier detection of IBP and diagnosis of axSpA in men versus women ( 26 , 27 , 28 ). Along their journey to diagnosis, more than one half of patients in this US cohort (64.5%) received a misdiagnosis.…”

Pain in axial spondyloarthritis: role of the JAK/STAT pathway

“…Furthermore, multivariate regression analysis revealed that fatigue occurred with greater severity and frequency in female patients (38). Indeed, gender differences exist with regard to the diagnostic journey and management of disease, including variations in healthcare that may favor the earlier detection and diagnosis of axSpA in men (51)(52)(53)(54)(55). While men with axSpA have a worse radiologic prognosis, women have a higher burden of disease and report higher levels of pain, especially in longer existing axSpA and neuropathic and widespread pain (56) that is associated with diagnostic delay and less responsiveness to TNF inhibitor (TNFi) treatment (54,55,57).…”

Biomechanics in the onset and severity of spondyloarthritis: a force to be reckoned with

“…46 A 5-year prospective study reported differential effects of risk factors on disease progression in both the sexeswith smoking being an important predictor in men and bisphosphonate therapy being more important in women. 47 Enthesitis and dactylitis are more common and severe in female patients, and studies report that males have acute anterior uveitis more frequently. 48 There have also been investigations reporting a lower response rate to TNFi therapy in women compared with men.…”

“…A recent study examining differences in early diagnostic coding and specialty doctor visits between men and women on their journey to a final diagnosis of AS in a commercial research database revealed marked divergences. 47 An alternate explanation for not only these recent findings, but potentially for many of the prior studies that allegedly demonstrated dissimilarities in disease phenotypes between men and women, can be explained by a cognitive bias whereby healthcare practitioners use different tools and testing mechanisms when approaching the diagnosis of AS in women versus men. We postulate that differences between the genders in SpA disease severity may be only partially linked to differences in anatomy between the two genders; however, the literature focusing on this area needs greater exploration.…”