Medical School of Chinese PLA, Beijing, China.
Department of Orthopaedics, The First Medical Centre, Chinese PLA General Hospital, Beijing, China.
Orthop Surg. 2022 Feb;14(2):405-410. doi: 10.1111/os.13123. Epub 2021 Dec 13.
To determine the gender differences in ankylosing spondylitis (AS) patients with advanced hip involvement.
We retrospectively analyzed the 373 consecutive AS patients with advanced hip involvement from 2012 to 2017 and divided them into two groups by sex with 340 men and 33 women. Research data on hip involvement in the patients were obtained from medical records and radiographs. The severity of radiographic hip involvement was evaluated by the Bath Ankylosing Spondylitis Radiology Hip Index (BASRI-hip) scoring system. The data on clinical characteristics, radiographic hip involvement, and laboratory values were compared between the two groups. The comparison was performed again between the two groups after adjusting for the onset age and disease duration by propensity score matching (PSM).
Men underwent total hip arthroplasty earlier than women in the patients, with a median age of 31 years (range, 19-67 years) vs 36 years (range, 23-67 years), respectively (P < 0.05). Hip involvement was found to be younger in men than that in women, with a median age of 18 years (range, 7-56 years) vs 23 years (range, 5-55 years) (P < 0.05), and men with bilateral onset in hips had a higher frequency than women with that (66.2% vs 39.4%) (P < 0.05). There was no gender difference in the proportion of bilateral advanced hip involvement (85.3% vs 72.7%) (P > 0.05). The proportion of the patients who had spinal involvement (89.1% vs 69.7%), flexion contracture in the hip (43.8% vs 24.2%), hip range of motion =0° (53.5% vs 30.3%), and an elevated level of C-reactive protein (CRP) (69.1% vs 51.5%) was significantly higher in men than that in women (P < 0.05). After adjusting for the onset age and disease duration by PSM (1:1), men with bilateral onset in hips still had a higher frequency than women with that (76.7% vs 40.0%), and the proportion of the patients who had spinal involvement (90.0% vs 66.7%) and an elevated level of CRP (80.0% vs 53.3%) was significantly higher in men than that in women (P < 0.05).
The disease pattern of hip involvement in AS has gender differences, with bilateral onset being the dominant pattern in men and unilateral onset being more common in women. However, the frequency of bilateral advanced hip involvement has no gender difference eventually. The higher prevalence of spinal involvement in men with AS may be responsible for the more severe functional impairment compared with women.
确定髋关节受累的强直性脊柱炎（AS）患者的性别差异。
我们回顾性分析了 2012 年至 2017 年间 373 例髋关节受累的连续 AS 患者，并按性别分为两组，男性 340 例，女性 33 例。从病历和 X 线片中获取患者髋关节受累的研究数据。采用 Bath 强直性脊柱炎放射学髋关节指数（BASRI-hip）评分系统评估放射影像学髋关节受累的严重程度。比较两组患者的临床特征、髋关节受累和实验室检查结果。采用倾向性评分匹配（PSM）调整发病年龄和病程后，再次比较两组患者。
男性髋关节全髋关节置换术的年龄早于女性，分别为 31 岁（范围，19-67 岁）和 36 岁（范围，23-67 岁）（P<0.05）。男性髋关节受累年龄较女性年轻，中位年龄分别为 18 岁（范围，7-56 岁）和 23 岁（范围，5-55 岁）（P<0.05），双侧髋关节首发的男性比例高于女性（66.2%比 39.4%）（P<0.05）。双侧髋关节严重受累的比例在性别间无差异（85.3%比 72.7%）（P>0.05）。男性具有脊柱受累（89.1%比 69.7%）、髋关节屈曲挛缩（43.8%比 24.2%）、髋关节活动度=0°（53.5%比 30.3%）和 C 反应蛋白（CRP）升高（69.1%比 51.5%）的比例明显高于女性（P<0.05）。采用 PSM（1:1）调整发病年龄和病程后，双侧髋关节首发的男性比例仍高于女性（76.7%比 40.0%），具有脊柱受累（90.0%比 66.7%）和 CRP 升高（80.0%比 53.3%）的患者比例在男性中明显高于女性（P<0.05）。
髋关节受累的 AS 疾病模式存在性别差异，男性以双侧起病为主，女性以单侧起病为主。然而，双侧髋关节严重受累的发生率最终在性别间无差异。男性 AS 患者脊柱受累的患病率较高，可能导致与女性相比更严重的功能损害。
