Sex differences in axial spondyloarthritis

Detalhes bibliográficos
Autor(a) principal: Cunha, R. N.
Data de Publicação: 2022
Outros Autores: Sousa, E., Khmelinskii, N., Ávila, P., Couto, M., Seixas, M. I., Martins, N., Bernardes, M., Martins, A., da Silva, A. B., Lourenço, M. H., Miguel, C., Tavares, V., Valente, P., Costa, J., Rovisco, J., Aguiar, R., Afreixo, V., Barcelos, A.
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
Texto Completo: http://hdl.handle.net/10362/136061
Resumo: Background: Axial spondyloarthritis (axSpA), particularly ankylosing spondylitis was historically considered a male’s disease and has been under-recognized in women. Emerging evidence reveals sex differences in pathophysiology, disease presentation and therapeutic efficacy. Objective: To identify differences between sexes in a Portuguese cohort of patients with axSpA regarding clinical manifestations, disease activity, functional capacity, patient related outcomes and presence of sacroiliitis on x-ray or magnetic resonance imaging. Methods: Patients with ≥18 years fulfilling the ASAS-Assessment of Spondyloarthritis International Society classification criteria for axSpA registered in the electronic Rheumatic Diseases Portuguese Register (Reuma.pt) were included in this multicentric cross-sectional study. Sociodemographic data, clinical features and imaging were collected from the first record in Reuma.pt. These variables were compared between sexes using Mann-Whitney test and Chi-Square test. Variables with a significant association with variable sex were considered in the multiple variable analysis to adjust the sex effect on the outcome variables. Statistical analysis was performed with R version 4.0.2 and p<0.05 was considered statistically significant. Results: A total of 1995 patients were included, 1114 (55.9%) men and 881 (44.1%) women. Men had an earlier disease onset (25.1 vs 28.4, p<0.001), were younger at diagnosis (26.9 vs 30.4, p<0.001) and were more frequently smokers (32.1% vs 15.7%, p<0.001). Comparing to women, men had worse Bath Ankylosing Spondylitis Metrological Index scores (4.0 vs 3.4, p<0.001), higher levels of C-Reactive Protein (10.5 vs 6.9 mg/L, p<0.001) and were more often Human Leukocyte Antigen-B27 positive (67.8% vs 54%, p<0.001). In contrast, women more frequently had inflammatory bowel disease (8.8% vs 4.9%, p=0.004), higher levels of erythrocyte sedimentation rate (25.0 vs 21.0mm/h, p=0.003) and worse patient-related outcomes-Bath Ankylosing Spondylitis Disease Activity Index (5.7 vs 4.5, p<0.001), Patient Global Assessment (60.0 vs 50.0, p<0.001) and fatigue (6.2 vs 5.0, p<0.001). Discussion: In this large multicentric study from a Portuguese axSpA cohort, we confirmed sex differences in patients with axSpA. This work brings awareness to these differences, resulting in less underdiagnosis and misdiagnosis, optimizing treatment strategies, and improving outcomes in axSpA
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spelling Sex differences in axial spondyloarthritisdata from a Portuguese spondyloarthritis cohortAxial spondyloarthritisDisease activityExtra-articular manifestationsImagingSexMedicine(all)SDG 3 - Good Health and Well-beingBackground: Axial spondyloarthritis (axSpA), particularly ankylosing spondylitis was historically considered a male’s disease and has been under-recognized in women. Emerging evidence reveals sex differences in pathophysiology, disease presentation and therapeutic efficacy. Objective: To identify differences between sexes in a Portuguese cohort of patients with axSpA regarding clinical manifestations, disease activity, functional capacity, patient related outcomes and presence of sacroiliitis on x-ray or magnetic resonance imaging. Methods: Patients with ≥18 years fulfilling the ASAS-Assessment of Spondyloarthritis International Society classification criteria for axSpA registered in the electronic Rheumatic Diseases Portuguese Register (Reuma.pt) were included in this multicentric cross-sectional study. Sociodemographic data, clinical features and imaging were collected from the first record in Reuma.pt. These variables were compared between sexes using Mann-Whitney test and Chi-Square test. Variables with a significant association with variable sex were considered in the multiple variable analysis to adjust the sex effect on the outcome variables. Statistical analysis was performed with R version 4.0.2 and p<0.05 was considered statistically significant. Results: A total of 1995 patients were included, 1114 (55.9%) men and 881 (44.1%) women. Men had an earlier disease onset (25.1 vs 28.4, p<0.001), were younger at diagnosis (26.9 vs 30.4, p<0.001) and were more frequently smokers (32.1% vs 15.7%, p<0.001). Comparing to women, men had worse Bath Ankylosing Spondylitis Metrological Index scores (4.0 vs 3.4, p<0.001), higher levels of C-Reactive Protein (10.5 vs 6.9 mg/L, p<0.001) and were more often Human Leukocyte Antigen-B27 positive (67.8% vs 54%, p<0.001). In contrast, women more frequently had inflammatory bowel disease (8.8% vs 4.9%, p=0.004), higher levels of erythrocyte sedimentation rate (25.0 vs 21.0mm/h, p=0.003) and worse patient-related outcomes-Bath Ankylosing Spondylitis Disease Activity Index (5.7 vs 4.5, p<0.001), Patient Global Assessment (60.0 vs 50.0, p<0.001) and fatigue (6.2 vs 5.0, p<0.001). Discussion: In this large multicentric study from a Portuguese axSpA cohort, we confirmed sex differences in patients with axSpA. This work brings awareness to these differences, resulting in less underdiagnosis and misdiagnosis, optimizing treatment strategies, and improving outcomes in axSpANOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)Centro de Estudos de Doenças Crónicas (CEDOC)Comprehensive Health Research Centre (CHRC) - pólo NMSComprehensive Health Research Centre (CHRC) - Pólo ENSPCentro de Investigação em Saúde Pública (CISP/PHRC)Escola Nacional de Saúde Pública (ENSP)RUNCunha, R. N.Sousa, E.Khmelinskii, N.Ávila, P.Couto, M.Seixas, M. I.Martins, N.Bernardes, M.Martins, A.da Silva, A. B.Lourenço, M. H.Miguel, C.Tavares, V.Valente, P.Costa, J.Rovisco, J.Aguiar, R.Afreixo, V.Barcelos, A.2022-04-07T22:35:06Z2022-012022-01-01T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/article7application/pdfhttp://hdl.handle.net/10362/136061eng0303-464XPURE: 42453722info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2024-03-11T05:14:20Zoai:run.unl.pt:10362/136061Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-20T03:48:37.219276Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse
dc.title.none.fl_str_mv Sex differences in axial spondyloarthritis
data from a Portuguese spondyloarthritis cohort
title Sex differences in axial spondyloarthritis
spellingShingle Sex differences in axial spondyloarthritis
Cunha, R. N.
Axial spondyloarthritis
Disease activity
Extra-articular manifestations
Imaging
Sex
Medicine(all)
SDG 3 - Good Health and Well-being
title_short Sex differences in axial spondyloarthritis
title_full Sex differences in axial spondyloarthritis
title_fullStr Sex differences in axial spondyloarthritis
title_full_unstemmed Sex differences in axial spondyloarthritis
title_sort Sex differences in axial spondyloarthritis
author Cunha, R. N.
author_facet Cunha, R. N.
Sousa, E.
Khmelinskii, N.
Ávila, P.
Couto, M.
Seixas, M. I.
Martins, N.
Bernardes, M.
Martins, A.
da Silva, A. B.
Lourenço, M. H.
Miguel, C.
Tavares, V.
Valente, P.
Costa, J.
Rovisco, J.
Aguiar, R.
Afreixo, V.
Barcelos, A.
author_role author
author2 Sousa, E.
Khmelinskii, N.
Ávila, P.
Couto, M.
Seixas, M. I.
Martins, N.
Bernardes, M.
Martins, A.
da Silva, A. B.
Lourenço, M. H.
Miguel, C.
Tavares, V.
Valente, P.
Costa, J.
Rovisco, J.
Aguiar, R.
Afreixo, V.
Barcelos, A.
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)
Centro de Estudos de Doenças Crónicas (CEDOC)
Comprehensive Health Research Centre (CHRC) - pólo NMS
Comprehensive Health Research Centre (CHRC) - Pólo ENSP
Centro de Investigação em Saúde Pública (CISP/PHRC)
Escola Nacional de Saúde Pública (ENSP)
RUN
dc.contributor.author.fl_str_mv Cunha, R. N.
Sousa, E.
Khmelinskii, N.
Ávila, P.
Couto, M.
Seixas, M. I.
Martins, N.
Bernardes, M.
Martins, A.
da Silva, A. B.
Lourenço, M. H.
Miguel, C.
Tavares, V.
Valente, P.
Costa, J.
Rovisco, J.
Aguiar, R.
Afreixo, V.
Barcelos, A.
dc.subject.por.fl_str_mv Axial spondyloarthritis
Disease activity
Extra-articular manifestations
Imaging
Sex
Medicine(all)
SDG 3 - Good Health and Well-being
topic Axial spondyloarthritis
Disease activity
Extra-articular manifestations
Imaging
Sex
Medicine(all)
SDG 3 - Good Health and Well-being
description Background: Axial spondyloarthritis (axSpA), particularly ankylosing spondylitis was historically considered a male’s disease and has been under-recognized in women. Emerging evidence reveals sex differences in pathophysiology, disease presentation and therapeutic efficacy. Objective: To identify differences between sexes in a Portuguese cohort of patients with axSpA regarding clinical manifestations, disease activity, functional capacity, patient related outcomes and presence of sacroiliitis on x-ray or magnetic resonance imaging. Methods: Patients with ≥18 years fulfilling the ASAS-Assessment of Spondyloarthritis International Society classification criteria for axSpA registered in the electronic Rheumatic Diseases Portuguese Register (Reuma.pt) were included in this multicentric cross-sectional study. Sociodemographic data, clinical features and imaging were collected from the first record in Reuma.pt. These variables were compared between sexes using Mann-Whitney test and Chi-Square test. Variables with a significant association with variable sex were considered in the multiple variable analysis to adjust the sex effect on the outcome variables. Statistical analysis was performed with R version 4.0.2 and p<0.05 was considered statistically significant. Results: A total of 1995 patients were included, 1114 (55.9%) men and 881 (44.1%) women. Men had an earlier disease onset (25.1 vs 28.4, p<0.001), were younger at diagnosis (26.9 vs 30.4, p<0.001) and were more frequently smokers (32.1% vs 15.7%, p<0.001). Comparing to women, men had worse Bath Ankylosing Spondylitis Metrological Index scores (4.0 vs 3.4, p<0.001), higher levels of C-Reactive Protein (10.5 vs 6.9 mg/L, p<0.001) and were more often Human Leukocyte Antigen-B27 positive (67.8% vs 54%, p<0.001). In contrast, women more frequently had inflammatory bowel disease (8.8% vs 4.9%, p=0.004), higher levels of erythrocyte sedimentation rate (25.0 vs 21.0mm/h, p=0.003) and worse patient-related outcomes-Bath Ankylosing Spondylitis Disease Activity Index (5.7 vs 4.5, p<0.001), Patient Global Assessment (60.0 vs 50.0, p<0.001) and fatigue (6.2 vs 5.0, p<0.001). Discussion: In this large multicentric study from a Portuguese axSpA cohort, we confirmed sex differences in patients with axSpA. This work brings awareness to these differences, resulting in less underdiagnosis and misdiagnosis, optimizing treatment strategies, and improving outcomes in axSpA
publishDate 2022
dc.date.none.fl_str_mv 2022-04-07T22:35:06Z
2022-01
2022-01-01T00:00:00Z
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