Are there gender differences in severity of ankylosing spondylitis? Results from the PSOAS cohort

• Published in: Annals of the rheumatic diseases Vol. 66; no. 5; pp. 633 - 638
• Main Authors: Lee, Wonuk, Reveille, John D, Davis, John C, Learch, Thomas J, Ward, Michael M, Weisman, Michael H
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and European League Against Rheumatism 01.05.2007; BMJ; BMJ Publishing Group LTD; BMJ Group
• Subjects: Age; Age of Onset; ankylosing spondylitis; Arthritis; BASFI; BASRI; BASRI-spine; Bath Ankylosing Spondylitis Functional Index; Bath Ankylosing Spondylitis Radiographic Index; Bath Ankylosing Spondylitis Radiographic Index Spine; Biological and medical sciences; Cohort Studies; Disability Evaluation; Diseases of the osteoarticular system; Diseases of the spine; Extended Report; Family medical history; Female; Gender differences; HAQ-S; Health Assessment Questionnaire for the Spondyloarthropathies; HLA; human leucocyte antigen; Humans; Inflammatory joint diseases; Joint surgery; Joints - physiopathology; Male; Medical sciences; Mens health; Middle Aged; Pain Measurement; Prospective Study of Outcomes in Ankylosing Spondylitis; PSOAS; Radiography; Severity of Illness Index; Sex Factors; Spine - diagnostic imaging; Spondylitis, Ankylosing - diagnostic imaging; Spondylitis, Ankylosing - physiopathology; Studies; Surveys and Questionnaires; Womens health; California; Spondylarthropathy; Chronic; Diseases of the osteoarticular system; Inflammatory joint disease; Spine disease; Iliopsoas muscle; Ankylosing spondylitis
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/ard.2006.060293

Objective: To examine the clinical and radiographic features in men and women in the Prospective Study of Outcomes in Ankylosing Spondylitis cohort, a large well-defined cross-sectional study of patients with AS, in order to understand the influence of gender in determining the severity of ankylosing spondylitis. Methods: Extensive clinical assessments and spine radiographs were performed in 302 men and 100 women with AS of ⩾20 years duration. Radiographs were scored using the Bath Ankylosing Spondylitis Radiographic Index Spine (BASRI-spine) score (range 2–12). Functional impairment was measured by the Bath Ankylosing Spondylitis Functional Index (BASFI) and the Health Assessment Questionnaire for the Spondyloarthropathies (HAQ-S). Results: Radiographic severity was worse among men. The unadjusted median BASRI-spine score for men was 10, compared with 6.5 for women (p<0.001). Functional disability, as measured by the BASFI and HAQ-S, was not different between men and women. However, after adjusting for radiographic spinal damage, women were found to report worse functioning than men at any given level of radiographic damage. Women had a slightly earlier age of disease onset; however, disease duration was identical in both groups. Women more frequently reported family histories of AS in first-degree relatives and were more likely to be treated with intra-articular steroids, sulphasalazine and prednisone. Conclusions: Among patients with longstanding AS, men have more severe radiographic changes; findings of treatment differences suggest that women may have more peripheral arthritis. At any given level of radiographic damage, self-reported functional limitations were worse for women.