Gender and disease features in Moroccan patients with ankylosing spondylitis

Abstract

This study was conducted to determine differences in ankylosing spondylitis (AS) between men and women in terms of clinical characteristics, biological features, structural severity and quality of life (QoL). A total of 130 consecutive AS patients fulfilling the modified New York criteria were included. Sociodemographic data were collected. The activity of disease was assessed by the Bath ankylosing spondylitis disease activity index (BASDAI) and the functional disability by the Bath Ankylosing spondylitis functional index (BASFI). Spinal mobility was measured using the occiput-to-wall distance, chest expansion, Schober index and the Bath Ankylosing Spondylitis Metrology Index (BASMI). The Bath Ankylosing Spondylitis Radiologic Index (BASRI) was used to evaluate structural damage. Fatigue was evaluated using a visual analogue scale and the QoL was measured by using the generic instrument SF-36. Laboratory tests included the erythrocyte sedimentation rate (ESR) and the C-reactive protein (CRP). In our sample, there were 87 (66.9%) men and 43 (33.1%) women. Women had significantly lower educational levels but there were no differences in socioeconomic status, age at onset, diagnosis delay, disease duration or treatments. Also, women had higher clinical disease activity (morning stiffness and BASDAI score), higher number of tender joints, more severe enthesitis and higher scores of fatigue (for all p ≤ 0.05). Moreover, hip involvement was more prevalent in men and the impairment of spinal mobility was significantly worse compared to women (for all p ≤ 0.001). Men had worse radiographic damage and lower scores in physical and social domains of QoL, but there were no differences in functional impairment scores. In this study, we noticed that AS presents differently according to gender in our patients. More longitudinal studies seem to be necessary to identify gender-related parameters of disease, thing that may help in diagnosis and therapeutic management of our AS patients.

Understanding How the Diagnostic Delay of Spondyloarthritis Differs Between Women and Men: A Systematic Review and Metaanalysis

“…Although 9 papers mention the concepts of social events 21,47 , social support 21,42 , social system 21 , social situation 27,30 , effect and consequences 11,21 , social status 15,21,23,28 , social domain and function 31 , and quality of life 21,31 , they are not in relation to social/sex-related causes explaining sex differences in delay in diagnosis. Only Aggarwal in 2009 adequately discussed the complex range of sex factors involved in the diagnostic process of SpA according to sex 8 .…”

“…Delay in diagnosis of SpA has been described in women 5,9,10 and in both sexes 6,7,[11][12][13][14][15][16]20,26,27,29,30,32,33,35,38,39,40,44,45,46 , and although Bandinelli 23 observed less diagnostic delay in women than in men, in most of the papers where delay was compared between men and women, it was greater in women 8,17,18,19,21,22,28,31,34,37,41,42,43,47,48 . This implies that patients have had medically unsolved disorders for a long time, have continued searching for a diagnosis and treatment, or are being erroneously diagnosed and managed 49 .…”

“…Table 1 shows the main characteristics of the 42 studies on diagnostic delay in SpA included in this systematic review 1,2,3,[8][9][10][11][12][13][14][15][16][17][18]19,20,21,22,23,[26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47]48 . The review included 23,883 patients (67.6% men, 32.3% women).…”

“…Although the disability rate is worse in women than in men at all ages 17 , women are identified as less disabled and with better spinal mobility than men 42 . These differences and the slower progression of radiological changes in women may influence earlier diagnosis in men, because the spine is more severely affected in them 31 .…”

“…This aspect is crucial to understanding whether diagnostic delay is related to the sex context of the female patient (i.e., personal/family history related to productive/reproductive roles on the basis of the delay in the demand for healthcare), or due to unfamiliarity with SpA in women by physicians from primary care or other levels of healthcare. The influence of social conditions was not normally included although it was discussed in a few papers 8,23,27,30,31,32,34 . It is a classic sex bias in which the research approach de-contextualizes women's health risks, blocking new knowledge about the chain of responsibility, in this case related to sex-related differences in diagnostic delay in SpA.…”