Gender differences in axial spondyloarthritis regarding clinical, radiological characteristics and response to treatment in an Egyptian Cohort Study

Abstract

Background
Axial spondyloarthritis (axSpA) was thought to be a male disease. Despite that recent data indicated a higher prevalence of female axSpA, female affection is still underrecognized, and more attention to disease characteristics among female patients is required to optimize management and improve disease outcomes.


Objective
To raise awareness of female axSpA and examine gender differences among the 200 studied patients as regards demographics, clinical presentations, radiological features, disease activity indices and response to treatment as regard the different therapies.


Results
Female patients had a higher rate of delayed diagnosis (p < 0.001) and were more likely to have peripheral arthritis and enthesitis among their first presentation. Males were presented more with inflammatory low back pain. The mean Ankylosing Spondylitis Disease Activity Score, Bath Ankylosing Spondylitis Disease Activity Index, and Bath Ankylosing Spondylitis Functional Index scores were higher among female patients p values = 0.308, 0.003, and 0.324, respectively. There was a statistically significant difference between the two groups as regard Bath Ankylosing Spondylitis Metrology Index, Maastricht Ankylosing Spondylitis Enthesitis Scores being higher among the studied female patients p < 0.001, and the Bath Ankylosing Spondylitis Radiology Index score was higher among male patients with p < 0.001. No statistically significant difference was found between the male and female patients as regard response to treatment after 12 weeks p = 0.075.


Conclusion
Females showed more delay in diagnosis compared to males. They also showed higher disease activity scores. However, males showed more radiological progression. There were no documented differences in the patients’ response to treatment.