Hellamand Pasoon, van de Sande Marleen G H, Nurmohamed Michael T, van Vollenhoven Ronald F, Hollick Rosemary J, Rotariu Ovidiu, Rotar Ziga, Pirkmajer Katja P, Nordström Dan, Hokkanen Anna-Mari, Michelsen Brigitte, Kvien Tore K, Glintborg Bente, Hetland Merete L, Østergaard Mikkel, Loft Anne G, Pavelka Karel, Zavada Jakub, Castrejon Isabel, Otero-Varela Lucia, Gudbjornsson Bjorn, Palsson Olafur, Olofsson Tor, Wallman Johan K, Ciurea Adrian, Nissen Michael J, Yildirim Tuba D, Onen Fatos, Codreanu Catalin, Mogosan Corina, Santos Maria J, Vieira-Sousa Elsa, Iannone Florenzo, Frediani Bruno, Ørnbjerg Lykke M, Twisk Jos W R, van der Horst-Bruinsma Irene E
Department of Clinical Immunology and Rheumatology, Amsterdam UMC, Location AMC, Free University of Amsterdam, Amsterdam, Netherlands.
Amsterdam Rheumatology and Immunology Center (ARC), Amsterdam, Netherlands.
Rheumatology (Oxford). 2025 Apr 1;64(4):1853-1863. doi: 10.1093/rheumatology/keae370.
To investigate sex differences in patient-reported outcome measures (PROMs) among axSpA patients initiating their first TNFi and identify factors contributing to these disparities over the follow-up.
Data were included from 15 EuroSpA registries and consisted of axSpA patients initiating their first TNFi, with ≥2 measurements for each analysed PROM (BASDAI and BASFI, scale 0-100) taken at any time point. Linear mixed models were employed to analyse sex differences in PROMs over 24 months and to evaluate how baseline characteristics were related to the observed sex differences.
We analysed 13 102 (38% women) in the BASDAI analyses and 10 623 (38% women) in the BASFI analyses. At follow-up, mean sex differences in BASDAI increased from 4.3 units at baseline (95% CI, 3.5-5.1) to 8.0 (7.2-8.8) at 6 months, and in BASFI from 2.2 (1.4-3.1) to 4.6 (3.6-5.5), with consistently worse scores in women. Baseline characteristics could not substantially account for the observed sex differences over time; however, the magnitude of the sex differences was reduced by HLA-B27 positivity, longer disease duration, and increased CRP levels, but increased by TNFi initiation in later years and peripheral arthritis.
In axSpA patients initiating their first TNFi, baseline sex differences in BASDAI and BASFI increased two-fold after 6 months of treatment and persisted thereafter, with worse scores in women. Several baseline characteristics moderated the sex differences, though none could fully account for them. These findings improve our understanding of sex differences and underscore their importance in axSpA.
研究首次使用肿瘤坏死因子抑制剂（TNFi）的轴向脊柱关节炎（axSpA）患者中患者报告的结局指标（PROMs）的性别差异，并确定在随访过程中导致这些差异的因素。
数据来自15个欧洲脊柱关节炎注册中心，包括首次使用TNFi的axSpA患者，每个分析的PROM（巴斯强直性脊柱炎疾病活动指数（BASDAI）和巴斯强直性脊柱炎功能指数（BASFI），范围0 - 100）在任何时间点均有≥2次测量值。采用线性混合模型分析24个月内PROMs的性别差异，并评估基线特征与观察到的性别差异之间的关系。
在BASDAI分析中，我们纳入了13102例患者（38%为女性），在BASFI分析中纳入了10623例患者（38%为女性）。在随访时，BASDAI的平均性别差异从基线时的4.3分（95%置信区间，3.5 - 5.1）增加到6个月时的8.0分（7.2 - 8.8），BASFI的平均性别差异从2.2分（1.4 - 3.1）增加到4.6分（3.6 - 5.5），女性得分始终更差。基线特征不能充分解释随时间观察到的性别差异；然而，HLA - B27阳性、疾病持续时间较长和C反应蛋白（CRP）水平升高会减小性别差异的幅度，而在晚年开始使用TNFi和存在外周关节炎则会增加性别差异的幅度。
在首次使用TNFi的axSpA患者中，治疗6个月后BASDAI和BASFI的基线性别差异增加了两倍，并在此后持续存在，女性得分更差。一些基线特征缓和了性别差异，但没有一个能完全解释这些差异。这些发现增进了我们对性别差异的理解，并强调了它们在axSpA中的重要性。
