ICYMI: Sex related differences in PsA Save

Different factors are known to influence disease characteristics and outcomes in psoriatic arthritis (PsA). Recently, there is new evidence that sex-related differences play a role not only in disease manifestations but also in efficacy and safety of treatments as well as outcomes and prognosis.

Although PsA occurs in males and females at similar rates, clinical manifestations and outcomes differ between sexes, yet still few randomized controlled trials report sex-disaggregated results.

In abstract 0588, the investigators evaluated the sex-related differences in baseline patient and disease characteristics in PsA.  The study included post hoc analysis of 1405 PsA patients from three guselkumab (IL-23i) trials among which 48% were female. Baseline characteristics showed female patients were older, had longer disease duration and higher BMI compared to male patients. It was also shown that female patients had higher tender joint counts and enthesitis while male patients had more skin involvement, higher CRP levels and dactylitis. While there were no differences observed in composite measures of disease activity, patient reported outcomes were significantly worse in female patients in terms of fatigue, functional impairment and pain. Interestingly, similar findings have been reported in patient registries across different regions of the world.

A fantastic session led by Professors Laura Coates and Lihi Eder, emphasized on the various aspects that could explain such differences which include genetic and hormonal components that change over time (e.g., pregnancy and menopause). Another important factor is the relationship with health care providers, given that despite seeking care earlier, female patients still experience an approximate 3-year delay in diagnosis of PsA.

Regarding treatment, it is known that pain mechanisms differ qualitatively and quantitatively between males and females and that sex hormones impact pain processing. There also seem to be differences in response to biologic vs conventional therapies, with studies showing males had stronger Th17 signatures while no differences were seen in Th1 responses. It was also shown that female patients were found to have more immunogenicity for TNFi, which was not found for conventional DMARDs or newer biologics.

These findings highlight the importance of considering biological sex and associated clinical features in the management of PsA, including the evaluation of response to treatment. While there is still a lot of work to do in terms of evaluation of these differences in current and future research, better understanding of the hormonal impact on the immune system over time and disaggregation of sex-related differences in RCTs will be an initial step for further analyses.