L.C. Coates, MBChB, MRCP, PhD, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, Oxfordshire, UK;
I.E. van der Horst-Bruinsma, MD, PhD, Department of Rheumatology, ZH0D53, Amsterdam UMC/VU University Medical Centre, Amsterdam, the Netherlands.
J Rheumatol. 2023 Apr;50(4):488-496. doi: 10.3899/jrheum.220386. Epub 2022 Oct 15.
A systematic review of published literature was conducted to collate evidence on sex-specific differences in clinical characteristics, disease activity, and patient-reported outcomes (PROs) in psoriatic arthritis (PsA), including response to treatment.
Searches of MEDLINE, Embase, and the Cochrane Database of Systematic Reviews were performed in November 2020 for observational studies of adults with PsA reporting outcomes by sex (published from January 1, 2015, to November 13, 2020). In addition, hand searches of systematic literature reviews and (network) metaanalysis bibliographies were performed. Searches of ClinicalTrials.gov and congress abstracts from the European Alliance of Associations for Rheumatology, the American College of Rheumatology (ACR), and the American Academy of Dermatology (2019-2020) were also carried out. Eligible studies with 100 or more patients prespecified a comparison by sex and reported clinical characteristics and/or disease activity. Data extracted included patient characteristics, study design, baseline clinical characteristics, and disease activity results, including PROs.
Database searching yielded 3283 unique records; 31 publications of 27 unique studies were included. The review found generally higher rates of peripheral disease in women, including higher tender joint counts. There was some evidence of more axial disease in men, plus greater skin disease burden. There were consistently no differences in Dermatology Life Quality Index scores, though across other PROs, women had worse scores, including pain and fatigue. Women had poorer responses to treatment, indicated by outcome measures such as ACR responses and minimal disease activity.
This review indicates that important differences exist between the sexes in PsA. However, the limited evidence for this conclusion underlines the need for additional research in this area.
系统回顾已发表文献，整理有关银屑病关节炎（PsA）患者临床特征、疾病活动度和患者报告结局（PROs）的性别特异性差异的证据，包括对治疗的反应。
2020 年 11 月，对 MEDLINE、Embase 和 Cochrane 系统评价数据库进行检索，以查找报告性别（自 2015 年 1 月 1 日至 2020 年 11 月 13 日发表）的成人 PsA 观察性研究。此外，还对手册系统评价和（网络）荟萃分析的参考文献进行了检索。还对 ClinicalTrials.gov 以及欧洲风湿病联盟、美国风湿病学会（ACR）和美国皮肤病学会的会议摘要（2019-2020 年）进行了检索。符合条件的研究纳入了 100 例或更多患者，并按性别进行了比较，且报告了临床特征和/或疾病活动度。提取的数据包括患者特征、研究设计、基线临床特征和疾病活动度结果，包括 PROs。
数据库检索产生了 3283 条独特记录；纳入了 31 篇文献的 27 项研究。综述发现，女性外周疾病的发生率普遍较高，包括更多的压痛关节数。男性的轴向疾病有一定的证据，皮肤疾病负担也更大。Dermatology Life Quality Index 评分始终没有差异，尽管在其他 PROs 中，女性的评分更差，包括疼痛和疲劳。女性对治疗的反应较差，这一点可以通过 ACR 反应和最小疾病活动度等结局指标来表明。
本综述表明，在 PsA 中，男女之间存在重要的差异。然而，这一结论的证据有限，突出了在这一领域进行更多研究的必要性。
