Artikel
Sex differences in clinical phenotype and radiographic disease progression in axial spondyloarthritis: results from the GErman SPondyloarthritis Inception Cohort
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Autoren
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Mikhail Protopopov
- Charité - Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie, Rheumatologie, Berlin
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Murat Torgutalp
- Charité - Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie, Rheumatologie, Berlin
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Joachim Sieper
- Charité - Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie, Rheumatologie, Berlin
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Hildrun Haibel
- Charité - Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie, Rheumatologie, Berlin
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Fabian Proft
- Charité - Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie, Rheumatologie, Berlin
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Martin Rudwaleit
- Klinikum Bielefeld Rosenhöhe, Bielefeld
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Denis Poddubnyy
- Charité - Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie, Rheumatologie, Berlin
| Veröffentlicht: | 8. Oktober 2019 |
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Gliederung
Text
Background: It is presumed that the phenotype of the axial spondyloarthritis (axSpA) may differ in females and males, but the published data are controversial. The objective of the study was to explore the sex differences in disease features and radiographic progression in axSpA.
Methods: A total of 210 patients with axSpA (115 with radiographic and 95 with non-radiographic axSpA) were included in the analysis. Radiographs of the spine and sacroiliac joints (SIJ) were scored by two trained readers in a randomly selected order according to the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) and the grading system of the modified New York criteria. A sacroiliitis sum score was calculated as a sum of the grades for the left and right SIJ. A multivariable regression analysis was performed to analyze the influence of sex on radiographic spinal progression and progression of radiographic sacroiliitis.
Results: Males (n=107; 51%) were significantly younger at disease onset (31.5±11.2 vs 34.8±10.3 years; p=0.008) and at diagnosis (34.1±11.2 vs 37.5±10.2 years; p=0.006. Females were less often human leukocyte antigen (HLA)-B27 positive (72.5% vs 86.0%; p=0.016), had higher baseline Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) levels (4.3±2.2 vs 3.7±2.0; p=0.05), but somewhat lower baseline C-reactive protein levels (7.1±10.9 vs 12.3±18.2; p=0.081), and similar time-averaged Ankylosing Spondylitis Disease Activity Score (ASDAS) levels (2.5±0.8 vs 2.4±1.0; p=0.385). Males more frequently had definite radiographic sacroiliitis (70.1% vs. 38.8%; p<0.001), higher sacroiliitis sum score (4.9 ±1.9 vs 3.2±1.8, p<0.001), and higher mean mSASSS (6.1 ± 10.7 vs 2.4 ± 4.0; p=0.100) at baseline (Table 1 [Tab. 1]).
In a multivariable regression analysis, there was no significant association of sex with radiographic progression in the spine or sacroiliac joints (Table 2 [Tab. 2]).
Conclusion: In GESPIC, females had later disease onset, higher BASDAI and less radiographic damage at baseline, but similar ASDAS scores and similar rates of radiographic progression in the spine and sacroiliac joints within the 2-year observation period in comparison to males.
