Association of Women in Rheumatology, 345 E 37th Street, Suite 303C, New York, NY 10016, USA.
Independent Healthcare Associates, Inc, Cullowhee, NC, USA.
Semin Arthritis Rheum. 2020 Aug;50(4):687-694. doi: 10.1016/j.semarthrit.2020.05.005. Epub 2020 May 25.
Axial spondyloarthritis (axSpA) is a chronic inflammatory immune-mediated disease resulting in inflammatory low back pain and other inflammatory manifestations in peripheral joints and entheses. AxSpA encompasses both ankylosing spondylitis (AS), in which patients present with definitive sacroiliitis visible on radiographic imaging, as well as nonradiographic axSpA (nr-axSpA), in which such changes may not be discernable. Emerging evidence suggests that women and men experience axSpA differently. Although the prevalence of AS is approximately 2- to 3- fold higher in men than in women, nr-axSpA occurs with roughly equal frequency in women and men. The goal of this review is to increase awareness of sex differences in axSpA by exploring the distinct manifestations of disease and disease characteristics in women, the overall clinical burden, recommendations for diagnosis, and potential treatment options. We summarize and contextualize the results of recent studies that illuminate sex differences in nr-axSpA and AS, including differences in disease manifestation and progression. It is important that sex differences in axSpA are understood and considered when diagnosing and treating the spectrum of axSpA, including AS and nr-axSpA.
中轴型脊柱关节炎（axSpA）是一种慢性炎症性免疫介导疾病，导致炎症性下腰痛和外周关节及附着点的其他炎症表现。axSpA 包括强直性脊柱炎（AS），患者在影像学上表现为明确的骶髂关节炎，以及非影像学 axSpA（nr-axSpA），在这种情况下可能无法察觉这些变化。新出现的证据表明，女性和男性患 axSpA 的方式不同。尽管 AS 的患病率在男性中约为女性的 2-3 倍，但 nr-axSpA 在女性和男性中的发生频率大致相同。本综述的目的是通过探讨疾病在女性中的不同表现和疾病特征、整体临床负担、诊断建议和潜在治疗选择，提高对 axSpA 中性别差异的认识。我们总结和阐述了最近阐明 nr-axSpA 和 AS 中性别差异的研究结果，包括疾病表现和进展的差异。在诊断和治疗 axSpA 谱，包括 AS 和 nr-axSpA 时，了解和考虑 axSpA 中的性别差异非常重要。
