Gender Differences in Clinical and Radiological Features Amongst Patients with Axial Spondyloarthropathy
DOI:
https://doi.org/10.51253/pafmj.v75iSUPPL-2.9060Keywords:
Axial Spondyloarthropathy (axSpA), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Enthesitis, Peripheral Arthritis, Sacroiliac Joint (SIJ), Uveitis.Abstract
Objective: To identify gender based clinical and radiological differences in patients with axial spondyloarthropathy.
Study Design: Comparative, cross-sectional study.
Place and Duration of Study: Rheumatology Department, Fauji Foundation Hospital, Rawalpindi Pakistan, from june to Dec 2021.
Methodology: 100 patients (50 males and 50 females) were selected, who were diagnosed with axial spondyloarthropathy according to Assessment of Spondylarthritis international society criteria. Demographic data, clinical characteristics, Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Functional Index, X-ray and magnetic resonance imaging findings of sacroiliac joints were recorded. Gender groups were compared using Student t-test, chi square and regression analysis.
Results: The mean age was 35.32±8.66 in males and35.46±9.28 in females. Females had higher involvement of cervico-thoracic region (OR= 4.82, p =0.01, 95% CI: 0.96-24.06), peripheral arthritis (OR= 3.18, p =0.007, 95% CI: 0.13-0.72), delay in diagnosis (OR= 3.55, p <001, 95% CI: 2.23-5.67), enthesitis (OR= 4.37, p =0.001, 95%CI:0.09-0.53). The mean Bath ankylosing spondylitis disease activity score was higher in females (OR= 1.36, p =0.002, 95% CI: 1.12-1.64). Mean Bath ankylosing spondylitis functional index was 5.22±2.3. Smoking in males had a significant correlation with disease. Males had more severe radiographic involvement.
Conclusion: Females with axial spondyloarthropathy are found to have a higher disease activity, more frequent cervico-thoracic pain, peripheral arthritis and enthesitis as compared to males. Males have more advanced radiographic involvement of sacroiliac joint.
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References
Wright GC, Kaine J, Deodhar A. Understanding differences between men and women with axial spondyloarthritis. Seminars in Arthritis and Rheumatism 2020; 50: 687–694.
https://doi.org/10.1016/J.SEMARTHRIT.2020.05.005
Rudwaleit M, van der Heijde D, Landewé R, Listing J, Akkoc N, Brandt J, et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): Validation and final selection. Annals of the Rheumatic Diseases 2009; 68: 777–783.
https://doi.org/10.1136/ARD.2009.108233
Baumberger H, Khan M. SAT0417 Gradual progressive change to equal prevalence of ankylosing spondylitis among males and females in switzerland: data from the swiss ankylosing spondylitis society (SVMB). Annals of the Rheumatic Diseases 2017; 76: 929–929.
https://doi.org/10.1136/ANNRHEUMDIS-2017-EULAR.3961
Chimenti M-S, Alten R, -AntonietaD’agostino M, Gremese E, Kiltz U, Lubrano E, et al. Sex-associated and gender-associated differences in the diagnosis and management of axial spondyloarthritis: addressing the unmet needs of female patients. Open 2021; 7: 1681.
https://doi.org/10.1136/rmdopen-2021-001681
Rusman T, van Bentum RE, van der Horst-Bruinsma IE. Sex and gender differences in axial spondyloarthritis: myths and truths. Rheumatology 2020; 59: iv38–46.
https://doi.org/10.1093/RHEUMATOLOGY/KEAA543
Ramiro S, van der Heijde D, van Tubergen A, Stolwijk C, Dougados M, van den Bosch F, et al. Higher disease activity leads to more structural damage in the spine in ankylosing spondylitis: 12-year longitudinal data from the OASIS cohort n.d. https://doi.org/10.1136/annrheumdis-2014-205178
Lubrano E, Perrotta FM, Manara M, Angelo SD’, Addimanda O, Ramonda R, et al. The Sex Influence on Response to Tumor Necrosis Factor-α Inhibitors and Remission in Axial Spondyloarthritis. The Journal of Rheumatology 2017; 45: 195–201. https://doi.org/10.3899/jrheum.170666
Ibáñez Vodnizza SE, van Bentum RE, Valenzuela O, van der Horst-Bruinsma IE. Patients with axial spondyloarthritis report significant differences between men and women and high impact of the disease: Large websurvey analysis. Joint Bone Spine 2020; 87: 315–319.
https://doi.org/10.1016/J.JBSPIN.2020.02.004
Tournadre A, Pereira B, Lhoste A, Dubost JJ, Ristori JM, Claudepierre P, et al. Differences Between Women and Men With Recent-Onset Axial Spondyloarthritis: Results From a Prospective Multicenter French Cohort 2013.
https://doi.org/10.1002/acr.22001
Sieper J, van der Heijde D, Landewé R, Brandt J, Burgos-Vagas R, Collantes-Estevez E, et al. New criteria for inflammatory back pain in patients with chronic back pain: a real patient exercise by experts from the Assessment of SpondyloArthritis international Society (ASAS). Ann Rheum Dis 2009; 68: 784–788.
https://doi.org/10.1136/ARD.2008.101501
Dubreuil M, Deodhar AA. Axial spondyloarthritis classification criteria: the debate continues. CurrOpin Rheumatol 2017; 29: 317–322. https://doi.org/10.1097/BOR.0000000000000402
Kwon OC, Park M-C. BASDAI cut-off values corresponding to ASDAS cut-off values. Rheumatology (Oxford) 2021.
https://doi.org/10.1093/RHEUMATOLOGY/KEAB494
Zochling J. Measures of symptoms and disease status in ankylosing spondylitis: Ankylosing Spondylitis Disease Activity Score (ASDAS), Ankylosing Spondylitis Quality of Life Scale (ASQoL), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Global Score (BAS-G), Bath Ankylosing Spondylitis Metrology Index (BASMI), Dougados Functional Index (DFI), and Health Assessment Questionnaire for the Spondylarthropathies (HAQ-S). Arthritis Care Res (Hoboken) 2011; 63 Suppl 11: S47–S58.
https://doi.org/10.1002/ACR.20575
Kaya H, Gaillard F. Sacroiliitis grading (New York criteria). RadiopaediaOrg 2008. https://doi.org/10.53347/RID-2013
Farooqi A, Gibson T. Prevalence Of The Major Rheumatic Disorders In The Adult Population Of North Pakistan. vol. 37. 1998.
Hameed K, Gibson T. A Comparison Of The Prevalence Of Rheumatoid Arthritis And Other Rheumatic Diseases Amongst Pakistanis Living In England And Pakistan. vol. 36. 1997.
Saeed MA, Ahmed H, Faiq M, Aslam Z, Elaine Anwer Khan S, Batool S, et al. Prevalence of inflammatory back pain and radiographic axial spondyloarthritis in a semi-urban community of Lahore, Pakistan. Int J Rheum Dis 2021; 24: 207–215.
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