Gender differences in ankylosing spondylitis patients: Relation to clinical characteristics, functional status and disease activity

Abstract

To assess gender differences in Ankylosing Spondylitis (AS) patients regarding the clinical presentation, disease activity and functional status. Methods and findings: Forty AS patients; 21 males and 19 females, regularly following at the Rheumatology outpatient's clinic, Saudi German Hospital, Riyadh, KSA were included. Functional status and the disease activity were evaluated using Bath Ankylosing Spondylitis Functional Index (BASFI) and the Bath AS Disease Activity Index (BASDAI) respectively. Mean age was 34.3 ± 8.5 years with a comparable sex ratio (M:F 1.11:1). Morning stiffness was markedly lower in females (72.4 ± 52.4 vs 112.9 ± 44.4 minutes) (p=0.01).Bilateral sacroiliitis was significantly more in males (n=18; 85.7% vs n=13; 68.4%) (p=0.02).The Schöber's test was more limited and the finger-to-floor distance more increased in males (4.5 ± 0.8 cm and 40.7 ± 9.2 cm vs 4.9 ± 0.7 cm and 27.9 ± 9.7 cm; p=0.046 and p<0.001 respectively). Human leukocytic antigen-B27) was positive in 85.7% of males while rheumatoid factor was positive in only 3 females. BASFI showed significantly higher value in females (6.7 ± 1.1 vs 5.8 ± 1.4) (p=0.04), while BASDAI showed only a tendency to be higher in females. Using Magnetic resonance imaging of the sacroiliac joint, sacroiliitis was detected in all cases with signs of activity in 9 males and 7 females, erosions in 8 males and 5 females, effusion in 1 female and total ankylosis in 1 male. Conclusion: The clinical presentation and genetic background were more remarkable in the AS males; however the disease activity and functional impairment were increased in females. Radiological findings were comparable.Understanding the gender differences in AS may discern how this may impact future research, diagnosis and treatment.

Reviewing Disease Activity Indices in Spondyloarthritis From the Sex Perspective: A Systematic Review and Metaanalysis

“…Nearly all the studies (n = 38, 92.7%) were published in or after 2010, with 26 of them (63.4%) in or after 2015. According to the study design, 31 studies (75.6%) were cross-sectional, 14,24,[27][28][29][31][32][33][34][35][36][37][38]40,41,[44][45][46][47][48][49][53][54][55][56][57][58][59][60][61][62] 9 studies (22.0%) were cohort studies, 15,25,30,39,42,43,[50][51][52] and 1 was a case-control study. 26 Twenty-five studies (61.0%) included patients with AS, 15,25,26,[30][31][32][33][36][37]…”

“…All participants fulfilled SpA classification criteria, excluding 2 studies 32,40 that used general disease classification plus rheumatologic assessment, and 2 studies that did not identify their criteria. 28,44 Regarding the patients source, 21 studies (51.2%) included primary data or records from rheumatology departments, [24][25][26][27]29,31,33,35,36,38,39,41,45,47,49,50,54,55,58,59,60 8 studies (26.7%) included rheumatology patients from prospective cohorts, 14,15,42,43,51,52,56,62 6 studies included rheumatology patients from registries, 30,32,34,40,48,53 4 studies included patients from associations, 28,37,44,57 1 study included patients from the Bulgarian population, 46 and 1 cross-sectional study pooled 4 randomized controlled trials (RCTs). 61 The studies involved participants from 36 different countries, and most studies (80.5%) inc...…”

“…Quality assessment. Out of a maximum of 9 on the NOS, 11 studies were rated as 5, 41,44,46,48,49,51,54,55,57,58,60 10 studies as 6, 15,25,28,29,32,34,45,47,52,61 8 studies as 7, 14,24,26,30,36,38,40,50 and 12 studies as 8 27,31,33,35,37,39,42,43,53,56,59,62 (Supplementary Table 2, available with the online version of this article). In the selection section, all studies met at least half the items on the NOS, with the loss of initially eligible subjects being the main concern.…”

“…In the comparison section, 15 studies did not consider any potential confounder other than sex. 15,25,29,34,36,41,45,[47][48][49]51,54,55,57,58 In the outcome/response section, missing data were considered as possible in 8 studies. 14,30,32,34,48,52,56,62 Descriptive analysis.…”

Ankylosing spondylitis and undifferentiated spondyloarthritis: The relationship between living with these diseases and psychological well‐being

“…The worldwide prevalence of these diseases is expected to be between 0.5% and 1.4% of the population, with the symptoms beginning between the age of 15 and 45 (Exarchou et al, 2015). The prevalence is believed to be significantly higher in males at a ratio of approximately 3:1 (Haroon, Sayed, & Ghelta, 2018).…”