Sex Differences Found in axSpA Diagnosis, Disease Severity: Study

Widespread pain, arthritis increased the likelihood of diagnosis delay in women

Patricia Inacio PhD avatar

by Patricia Inacio PhD |

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Women with axial spondyloarthritis (axSpA) are diagnosed significantly later compared to men, according to a new study.

The presence of widespread pain and arthritis were the early symptoms most commonly found in women and linked with a diagnosis delay.

The study, “Gender-related differences in axial spondyloarthritis (axSpA) patients,” was published in The Egyptian Rheumatologist.

Axial spondyloarthritis is marked by chronic back pain and active inflammation of the sacroiliac joints (where the lower spine and pelvis connect), often leading to deformities that may result in walking and standing impairments. It’s known as ankylosing spondylitis (AS) when these changes can be seen on X-rays and as non-radiographic (nr)-axSpA when no such damage is detected by them.

Axial spondyloarthritis is more common in men and was for long considered a male disease but it also can affect women.

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Whether sex is linked with particular disease features is important to understand since this will enable early diagnosis and management that “could improve the outcome of the disease and prevent serious complications,” researchers wrote.

To assess potential sex-related differences in patients with axSpA, researchers analyzed clinical and demographic data of 76 men (mean age 36.7) and 38 women (mean age 39.2) diagnosed with axSpA and followed at two hospitals in Syria.

Disease duration was similar between both groups – mean of 11.5 years – but women were diagnosed significantly later (after a mean of 9.2 years) compared to men (after a mean of 6.7 years), despite a similar age at disease onset in both groups (mean age 25).

Early symptoms of arthritis, as well as widespread pain and fibromyalgia were significantly more common in women than men. Inflammatory low back pain was the first symptom among men.

Enthesitis, which refers to inflammation sites where tendons or ligaments insert into the bone, was significantly higher among women than men, 47.4% versus 15.8%. This contrasts with previous reports wherein enthesitis was more common in men, the researchers noted.

Peripheral arthritis followed the same trend, being significantly higher in women (39.5%) compared to men (21.1%).

Men had more severe damage to the spine and hip joints, as assessed by the Bath Ankylosing Spondylitis Radiology Index (BASRI) scores, 7.2 versus 4.6 points. Also, fusion of parts of the spine, or sacroiliitis, was worse in men. Syndesmophytes — a type of bony growth forming inside a ligament and common in AS – was more common in women (34.2% vs 25%).

Women had more severe disease activity than men, as evidenced by significantly higher mean scores (6.3 vs. 5.2 points) on the Bath Ankylosing Spondylits Disease Activity Index (BASDAI). They also had more severe functional limitations as shown by higher scores in the Bath Ankylosing Spondylitis Functional Index (BASFI), 6.1 versus 5.3 points.

Women were more frequently treated with methotrexate, a medication sometimes prescribed to treat severe rheumatoid arthritis, and Azulfidine (sulphasalazine).

Widespread pain and arthritis as initial presentations increased the chances for a delayed diagnosis in women, a statistical analysis showed.

These findings suggest that “clinical and initial presentations of axSpA differ between the two genders,” the researchers wrote. “The disease activity, functional limitation, and enthesitis score are higher in females.”

“While radiologic severity is worse in men, there is predominant cervical spine involvement in women,” they wrote.