Gender differences in Iranian patients with ankylosing spondylitis

Abstract

Inequalities in features and severity of ankylosing spondylitis (AS) have been noticed between men and women, suggesting a possible influence of gender on disease phenotypes. Comparing disease features and characterization of gender differences in clinical features and medications could help elucidate the potential influence of gender on the severity of AS in patients. This study aims to assess the influence of gender on disease patterns in Iranian patients with AS. Three hundred and twenty patients diagnosed with primary AS were assessed for demographic variables, clinical manifestations, HLA status, disease severity, functional capacities, quality of life, and treatment status. Sixty-seven women and 253 men were included corresponding to a male to female ratio of 3.78:1. Both groups were similar regarding ethnicity, positive family history, and juvenile onset AS. HLA-B27 was more frequent among males (78.3 vs. 55.2%; p < 0.001). There was a higher proportion of female patients with overall enthesitis (p < 0.05). Extra-articular manifestations and treatment modalities presented similar frequencies in both genders. No difference in gender-associated diagnostic delays was observed. Female disease was at least as severe as male disease, and in some aspects, females presented with more severe disease. Despite a relatively similar disease profile, we observed a higher rate of enthesitis among women. Together with the equally high rate of disease activity indices in both genders, these findings indicate an overall longer delay to diagnosis in our country. Early detection and specialized care would be of great practical importance.

Characterization of ankylosing spondylitis in Upper Egypt

“…The age of onset, age at diagnosis, disease duration and diagnostic delay were significantly higher in men than in women in our study. This is inconsistent with the findings of an Iranian study that reported a higher, but not significant, mean of these variables in women than in men [28]. Additionally, a previous Moroccan study reported findings completely opposite to our results regarding the age at onset [9].…”

“…A similar finding was also reported by previous studies from Turkey [24] and Iran [28], while a Moroccan study reported a more prevalent family history in women [9].…”

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).…”