Are There Gender Differences in Severity of Ankylosing Spondylitis? Results from the PSOAS Cohort

Overview

Journal Ann Rheum Dis

Specialty Rheumatology

Date 2006 Nov 28

PMID 17127685

Citations 108

Authors

Wonuk Lee

John D Reveille

John C Davis Jr

Thomas J Learch

Michael M Ward

Michael H Weisman

Affiliations

Soon will be listed here.

Abstract

Objective: To examine the clinical and radiographic features in men and women in the Prospective Study of Outcomes in Ankylosing Spondylitis cohort, a large well-defined cross-sectional study of patients with AS, in order to understand the influence of gender in determining the severity of ankylosing spondylitis.

Methods: Extensive clinical assessments and spine radiographs were performed in 302 men and 100 women with AS of > or = 20 years duration. Radiographs were scored using the Bath Ankylosing Spondylitis Radiographic Index Spine (BASRI-spine) score (range 2-12). Functional impairment was measured by the Bath Ankylosing Spondylitis Functional Index (BASFI) and the Health Assessment Questionnaire for the Spondyloarthropathies (HAQ-S).

Results: Radiographic severity was worse among men. The unadjusted median BASRI-spine score for men was 10, compared with 6.5 for women (p<0.001). Functional disability, as measured by the BASFI and HAQ-S, was not different between men and women. However, after adjusting for radiographic spinal damage, women were found to report worse functioning than men at any given level of radiographic damage. Women had a slightly earlier age of disease onset; however, disease duration was identical in both groups. Women more frequently reported family histories of AS in first-degree relatives and were more likely to be treated with intra-articular steroids, sulphasalazine and prednisone.

Conclusions: Among patients with longstanding AS, men have more severe radiographic changes; findings of treatment differences suggest that women may have more peripheral arthritis. At any given level of radiographic damage, self-reported functional limitations were worse for women.

Citing Articles

Females With Axial Spondyloarthritis Have Longer Diagnostic Delay and Higher Burden of the Disease. Results From the International Map of Axial Spondyloarthritis (IMAS).

Navarro-Compan V, Garrido-Cumbrera M, Poddubnyy D, Bundy C, Makri S, Correa-Fernandez J Int J Rheum Dis. 2024; 27(12):e15433.

PMID: 39655453 PMC: 11629135. DOI: 10.1111/1756-185X.15433.

Low Socioeconomic Status and Female Sex are Associated With Worse Functional Status in Axial Spondyloarthritis.

Stovall R, Li J, Fitzpatrick J, Roberts E, Palmowski A, Anastasiou C Arthritis Care Res (Hoboken). 2024; 77(3):376-384.

PMID: 39295233 PMC: 11850203. DOI: 10.1002/acr.25436.

Differences between radiographic and non-radiographic axial spondyloarthritis patients in a Mexican cohort.

Londono J, Pacheco-Tena C, Santos A, Cardiel M, Rodriguez-Salas G, Rueda I Sci Rep. 2024; 14(1):10342.

PMID: 38710901 PMC: 11074148. DOI: 10.1038/s41598-024-61001-w.

Circulating cell-free DNA correlate to disease activity and treatment response of patients with radiographic axial spondyloarthritis.

Peng Y, Wu Y, Chen S, Liu Y, Qian H, He Y Sci Rep. 2024; 14(1):178.

PMID: 38168507 PMC: 10762258. DOI: 10.1038/s41598-023-50543-0.

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

Iyer P, Hwang M, Ridley L, Weisman M RMD Open. 2023; 9(4).

PMID: 37949613 PMC: 10649803. DOI: 10.1136/rmdopen-2023-003372.

References

MASI A, Wilkins W . Does male:female sex ratio in ankylosing spondylitis change with age?. J Rheumatol. 1996; 23(5):947-8. View

Odegard S, Landewe R, van der Heijde D, Kvien T, Mowinckel P, Uhlig T . Association of early radiographic damage with impaired physical function in rheumatoid arthritis: a ten-year, longitudinal observational study in 238 patients. Arthritis Rheum. 2005; 54(1):68-75. DOI: 10.1002/art.21548. View

Spoorenberg A, van der Heijde D, de Klerk E, Dougados M, de Vlam K, Mielants H . A comparative study of the usefulness of the Bath Ankylosing Spondylitis Functional Index and the Dougados Functional Index in the assessment of ankylosing spondylitis. J Rheumatol. 1999; 26(4):961-5. View

Calin A, Garrett S, Whitelock H, Kennedy L, OHea J, Mallorie P . A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index. J Rheumatol. 1994; 21(12):2281-5. View

Carbone L, Cooper C, Michet C, Atkinson E, OFallon W, Melton 3rd L . Ankylosing spondylitis in Rochester, Minnesota, 1935-1989. Is the epidemiology changing?. Arthritis Rheum. 1992; 35(12):1476-82. DOI: 10.1002/art.1780351211. View

Spencer D, Park W, Dick H, Papazoglou S, BUCHANAN W . Radiological manifestations in 200 patients with ankylosing spondylitis: correlation with clinical features and HLA B27. J Rheumatol. 1979; 6(3):305-15. View

Gran J, Husby G, Hordvik M, Stormer J, Romberg-Andersen O . Radiological changes in men and women with ankylosing spondylitis. Ann Rheum Dis. 1984; 43(4):570-5. PMC: 1001409. DOI: 10.1136/ard.43.4.570. View

Babini S . Clinical features of ankylosing spondylitis in women and men and its relationship with age of onset. J Rheumatol. 1985; 12(1):179-80. View

Welsing P, van Gestel A, Swinkels H, Kiemeney L, van Riel P . The relationship between disease activity, joint destruction, and functional capacity over the course of rheumatoid arthritis. Arthritis Rheum. 2001; 44(9):2009-17. DOI: 10.1002/1529-0131(200109)44:9<2009::AID-ART349>3.0.CO;2-L. View

10.

Gomez K, Raza K, Jones S, Kennedy L, Calin A . Juvenile onset ankylosing spondylitis--more girls than we thought?. J Rheumatol. 1997; 24(4):735-7. View

11.

Ward M, Kuzis S . Validity and sensitivity to change of spondylitis-specific measures of functional disability. J Rheumatol. 1999; 26(1):121-7. View

12.

Wolfe F . A reappraisal of HAQ disability in rheumatoid arthritis. Arthritis Rheum. 2001; 43(12):2751-61. DOI: 10.1002/1529-0131(200012)43:12<2751::AID-ANR15>3.0.CO;2-6. View

13.

Resnick D, Dwosh I, Goergen T, Shapiro R, Utsinger P, Wiesner K . Clinical and radiographic abnormalities in ankylosing spondylitis: a comparison of men and women. Radiology. 1976; 119(2):293-7. DOI: 10.1148/119.2.293. View

14.

Marks S, Barnett M, Calin A . Ankylosing spondylitis in women and men: a case-control study. J Rheumatol. 1983; 10(4):624-8. View

15.

Jimenez-Balderas F, Mintz G . Ankylosing spondylitis: clinical course in women and men. J Rheumatol. 1993; 20(12):2069-72. View

16.

Hill H, HILL A, Bodmer J . Clinical diagnosis of ankylosing spondylitis in women and relation to presence of HLA-B27. Ann Rheum Dis. 1976; 35(3):267-70. PMC: 1006552. DOI: 10.1136/ard.35.3.267. View

17.

Doran M, Brophy S, MacKay K, Taylor G, Calin A . Predictors of longterm outcome in ankylosing spondylitis. J Rheumatol. 2003; 30(2):316-20. View

18.

Gran J, Ostensen M, Husby G . A clinical comparison between males and females with ankylosing spondylitis. J Rheumatol. 1985; 12(1):126-9. View

19.

Wanders A, Landewe R, Spoorenberg A, Dougados M, van der Linden S, Mielants H . What is the most appropriate radiologic scoring method for ankylosing spondylitis? A comparison of the available methods based on the Outcome Measures in Rheumatology Clinical Trials filter. Arthritis Rheum. 2004; 50(8):2622-32. DOI: 10.1002/art.20446. View

20.

Eustace S, Coughlan R, McCarthy C . Ankylosing spondylitis. A comparison of clinical and radiographic features in men and women. Ir Med J. 1993; 86(4):120-2. View