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Background: There is variability reported in disease profile of Axial Spondyloarthritis (axSpA) in terms of gender. (1) In low and middle-income countries, it is further complicated due to issues of access and gender discrimination. Objectives: To compare the demographic characteristics, disease activity scores at baseline, compliance, and outcome of treat to-target (T2T) approach between both genders in patients with axSpA in a real-world setting. Methods: This is the first retrospective analysis looking at gender differences in a cohort set up with the support of the Arthritis Care Foundation enrolling patients from two academic rheumatology departments and affiliated clinics in Lahore Pakistan. All enrolled patients gave an informed consent. Patients were diagnosed as axSpA as per ASAS classification criteria. Data regarding demography, disease parameters, and outcome measures like Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Assessment of Spondyloarthritis Disease Activity Score (ASDAS)-CRP were retrieved from electronic medical records. Compliance to Treat to target strategy in both groups was assessed by adaptations to treatment as per Assessment of SpondyloArthritis International Society (ASAS) recommendations. (2) For analysis data was entered into SPSS version 26. Results: There was a total of 270 axSpA patients enrolled from November 2019 to December 2023. Out of these, there were 218 (80.7 %) men and 52 (19.3 %) women. Women were found to be older than their counterparts at presentation (p=value 0.001). There was no statistically significant difference between the two genders in terms of disease duration at their first visit. However, there were more men with positive HLA-B 27 status 150 (69.4 %) vs 26 (50.0 %), p=0.000. There was no statistically significant difference In the frequency of peripheral arthritis and Uveitis. Females were reported to have higher BASDAI scores at baseline (p=0.003). Compliance to T2T by treating rheumatologists in terms of escalation of treatment was higher in male patients leading to higher use of biologic or targetted synthetic modifying rheumatic Drugs (tsDMARDs) in men (46 vs 22 % p=0.002). For a detailed comparison of outcome measures see Table 1. Conclusion: This study has highlighted that the burden of disease in women is higher than in men in terms of BASDAI and comparable for ASDAS-CRP. However, despite this, there is a disparity in terms use of biologics and tsDMARDs in females. There is an unmet need to address factors including issues of access for more vulnerable gender in our country where generally there is no coverage for out-patient rheumatic diseases. REFERENCES: 1 Rusman T, van Vollenhoven RF, van der Horst-Bruinsma IE. Gender Differences in Axial Spondyloarthritis: Women Are Not So Lucky. Curr Rheumatol Rep. 2018 May 12;20(6):35. doi: 10.1007/s11926-018-0744-2. PMID: 29754330; PMCID: PMC5949138. 2 Ramiro S, Nikiphorou E, Sepriano A, Ortolan A, Webers C, Baraliakos X, Landewé RB, Van den Bosch FE, Boteva B, Bremander A, Carron P. ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update. Annals of the rheumatic diseases. 2022 Oct 21. Acknowledgements: All the faculty and fellows of the Departments. Disclosure of Interests: None declared.
Saeed et al. (Sat,) studied this question.