M. Blasco-Blasco, PhD, Public Health Research Group, University of Alicante, Alicante, Spain;
I. Castrejón, MD, PhD, Division of Rheumatology, Rush University Medical Center, Chicago, Illinois, USA.
J Rheumatol. 2021 Sep;48(9):1395-1404. doi: 10.3899/jrheum.200967. Epub 2021 Apr 1.
To determine whether the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Ankylosing Spondylitis Disease Activity Score (ASDAS) exhibited differences between women and men.
We systematically searched MEDLINE, Embase, Web of Science, and other sources in English or Spanish from January 1, 1995, to July 31, 2020, to assess the differences according to sex in BASDAI and ASDAS. We performed a comparative analysis by sex using test and mean difference by sex metaanalyses for BASDAI and ASDAS, as well as a random-effects model using the inverse-variance method.
Forty-one studies included BASDAI (6785 women, 12,929 men) and 16 of them included ASDAS (2046 women, 4403 men). Disease activity detected using BASDAI was significantly higher in women than in men (mean 4.9 vs 4.2, = 0.02), whereas ASDAS did not detect differences between sexes (mean 2.8 women vs 2.8 men). In the metaanalyses, BASDAI detected significant differences between women and men (mean difference = 0.55 [95% CI 0.46-0.65], < 0.00001), but ASDAS did not identify significant mean difference between sexes (0.04, 95% CI -0.05 to 0.12], = 0.38).
The 2 most widely used indices of disease activity in spondyloarthritis (SpA) discriminate differently according to sex by their different evaluations of peripheral disease. The different components and weights in BASDAI and ASDAS influence their values. BASDAI may be affected by fatigue, and in predominantly peripheral manifestations such as enthesitis, ASDAS may not be sensitive enough to detect activity. This may represent a sex bias unfavorable to women, because peripheral SpA is more common in women than in men.
确定 Bath 强直性脊柱炎疾病活动指数（BASDAI）和强直性脊柱炎疾病活动评分（ASDAS）是否在女性和男性之间存在差异。
我们系统地检索了英文或西班牙文的 MEDLINE、Embase、Web of Science 及其他资源，检索时间为 1995 年 1 月 1 日至 2020 年 7 月 31 日，以评估 BASDAI 和 ASDAS 按性别差异的研究。我们使用 检验进行性别比较分析，使用性别 metaanalyses 进行 BASDAI 和 ASDAS 的均值差异分析，并使用逆方差法的随机效应模型。
41 项研究纳入了 BASDAI（6785 名女性，12929 名男性），其中 16 项研究纳入了 ASDAS（2046 名女性，4403 名男性）。使用 BASDAI 检测到的疾病活动在女性中明显高于男性（平均 4.9 比 4.2， = 0.02），而 ASDAS 则没有检测到性别差异（平均 2.8 名女性与 2.8 名男性）。在 metaanalyses 中，BASDAI 检测到女性与男性之间存在显著差异（平均差异=0.55[95%CI 0.46-0.65]， < 0.00001），而 ASDAS 则没有检测到性别间的显著平均差异（0.04，95%CI-0.05 至 0.12]， = 0.38）。
在 SpA 中，两种最广泛使用的疾病活动指数（BASDAI 和 ASDAS）根据其对周围疾病的不同评估，通过不同的方法进行区分。BASDAI 和 ASDAS 的不同组成部分和权重影响其值。BASDAI 可能受到疲劳的影响，在主要为外周表现的情况下，如附着点炎，ASDAS 可能不够敏感，无法检测到活动。这可能代表对女性不利的性别偏见，因为女性患外周性 SpA 的比例高于男性。
