Friday, 15 Feb 2019

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Does Gender Make a Difference in Axial Spondyloarthritis

Males and females can both be affected by axial spondyloarthritis (axSpA). A recent study shows that while there are some differences and similarities, HLA-B27 and imaging are still pivotal elements for diagnosis of axSpA in both genders.

The SPACE (SPondyloArthritis Caught Early) cohort was devised to assess adults with chronic back pain (CBP; duration ≥ 3 months and ≤ 2 years, age of onset < 45 years) and is the dataset for these analyses. 

From a total of 719 CBP patients, 275 were male and 444 were female. The subsequent diagnosis of axSpA was made in 53% of males and 35% of females. Thus males were more likely to be diagnosed with axSpA (OR 2.1, 95% CI 1.5–2.9).

Males differed from female axSpA patient by being younger at diagnosis (27.4  vs 29.5 years; p = 0.02), haveing more HLA-B27 positivity (80% vs 60%; p < 0.01) and more imaging positivity (MRI or radiograph sacroiliitis) (78% vs 64%; p = 0.01).

Women with SpA features did have the same symptom duration and were also HLA-B27+ (23%) and had  positive imaging studies 7% of the time.

In multivariate analyses, the diagnosis of axSpA was equally linked to HLA-B27 and imaging positivity in both sexes. Yet males and those who were HLA-B27+ were more likely to manifest imaging positivity.

These results do not endorse the need for separate diagnostic strategies for men and women with CBP.

The author has no conflicts of interest to disclose related to this subject

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