Impact of sex and HLA-B27 positivity on clinical characteristics and patient-reported outcomes in a cohort of Egyptian axial spondyloarthritis patients

Objective: To assess the clinical features, disease activity, functional status, and quality of life in Egyptian patients with axial spondyloarthritis (axSpA), and to explore the influence of gender and HLA-B27 status on disease expression. Methods: This cross-sectional study included 256 patients fulfilling ASAS criteria for axSpA. Clinical data, HLA-B27 status, laboratory markers, imaging findings, and treatment regimens were recorded. Disease activity was measured using ASDAS-CRP and BASDAI, functional status with BASFI, spinal mobility with BASMI, and quality of life with ASQoL. Statistical analyses were performed to assess gender and HLA-B27-related differences. Results: Of 256 patients (57.4% male), 55.9% were HLA-B27 positive and 70.3% had radiographic axSpA. The cohort demonstrated very high disease activity (mean ASDAS-CRP 4.57 ± 0.91), exceeding values reported in most international studies. Females showed more peripheral joint involvement and dactylitis, with higher BASDAI, BASFI, and ASQoL scores, indicating greater disease burden. HLA-B27 positive patients were more likely to have axial disease and elevated CRP levels, while HLA-B27 negative patients had higher rates of peripheral involvement, enthesitis, and dactylitis. HLA-B27 positivity was associated with better quality of life. Conclusion: AxSpA shows marked variability influenced by gender and HLA-B27 status. Female patients experience more severe symptoms and functional limitations, warranting tailored, gender-sensitive care. HLA-B27 positivity correlates with axial involvement and more favorable outcomes, underscoring its clinical relevance. Comprehensive, individualized treatment approaches are essential to address both physical and psychosocial aspects of the disease.