Serviço de Reumatologia, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal.
Serviço de Reumatologia, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte; Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, Portugal.
ARP Rheumatol. 2022 Jan-Mar;1(1):42-48.
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.
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.
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.
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).
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.
中轴型脊柱关节炎（axSpA），特别是强直性脊柱炎在历史上被认为是一种男性疾病，在女性中一直被低估。新出现的证据揭示了性别在病理生理学、疾病表现和治疗效果方面的差异。
本研究旨在葡萄牙 axSpA 患者队列中，确定性别在临床表现、疾病活动度、功能能力、患者相关结局以及 X 线或磁共振成像上存在的骶髂关节炎方面的差异。
本研究纳入了至少 18 岁、符合 ASAS-评估强直性脊柱炎国际协会 axSpA 分类标准并在葡萄牙风湿病电子登记处（Reuma.pt）登记的患者。从 Reuma.pt 的首次记录中收集社会人口统计学数据、临床特征和影像学资料。使用 Mann-Whitney 检验和卡方检验比较性别之间的差异。将与变量性别有显著关联的变量纳入多变量分析，以调整性别对结局变量的影响。统计分析使用 R 版本 4.0.2，p 值<0.05 被认为具有统计学意义。
本研究共纳入 1995 例患者，其中 1114 例（55.9%）为男性，881 例（44.1%）为女性。男性发病年龄较早（25.1 岁 vs 28.4 岁，p<0.001），诊断时年龄较小（26.9 岁 vs 30.4 岁，p<0.001），吸烟更为常见（32.1% vs 15.7%，p<0.001）。与女性相比，男性的 Bath 强直性脊柱炎测量指数评分更高（4.0 分 vs 3.4 分，p<0.001），C 反应蛋白水平更高（10.5 毫克/升 vs 6.9 毫克/升，p<0.001），人类白细胞抗原-B27 阳性率更高（67.8% vs 54%，p<0.001）。相比之下，女性更常患有炎症性肠病（8.8% vs 4.9%，p=0.004），红细胞沉降率更高（25.0 毫米/小时 vs 21.0 毫米/小时，p=0.003），患者相关结局更差，如 Bath 强直性脊柱炎疾病活动指数（5.7 分 vs 4.5 分，p<0.001）、患者总体评估（60.0 分 vs 50.0 分，p<0.001）和疲劳（6.2 分 vs 5.0 分，p<0.001）。
在这项来自葡萄牙 axSpA 队列的大型多中心研究中，我们证实了 axSpA 患者存在性别差异。这项工作引起了对这些差异的关注，从而减少了 axSpA 的漏诊和误诊，优化了治疗策略，并改善了 axSpA 的结局。
