Background Axial-Spondyloarthritis (ax-SpA) often shows a different clinical phenotype in females than in males. Radiographic changes are usually worse in males than in females while women report more functional limitations (1).
Objectives To investigate whether changes in spinal mobility under anti-TNF therapy, differ by gender.
Methods Assessment of the Bath status was performed at baseline and after 3, 6, 12 and 24 months respectively in ax-SpA patients (n=77) enrolled at the beginning of their first biologic treatment with anti-TNF. Non-parametric statistics were used. Significance represented as p<0.05.
Results Of the 77 ax-SpA patients 57 were males and 20 females. At baseline, no differences in mean age (37.4±10.4 vs. 35.2±9.9, p=0.352) nor in disease duration (105.9±118.9 vs. 90.9±102.0, p=0.776) were found. In addition, we did not observe differences in ESR (20.7±15.8 vs. 27.9±20.3, p=0.181) and CRP (16.2±19.2 vs. 10.3±10.6, p=0.299) values between the two groups. Disease activity (BASDAI) was high and not significantly different between groups (5.261±1.9 vs. 5.7±2.1, p=0.210). Physical function (BASFI) was moderately impaired in both groups (3.7±2.3 vs. 4.7±2.5, p=0.114). A non-significant difference in mobility of the cervical and lumbar spine and hip joints (BASMI) was present at baseline (3.7±1.8 vs. 2.8±1.6, p=0.081). At three months the average BASMI remained non-significantly different (3.1±1.9 vs. 2.4±1.4, p=0.118), but male patients had a greater improvement in BASMI score than female patients (Z=-4.3, p<0.001 vs. Z=-2.1, p=0.038). Likewise, mean values at 12 and 24 months were not significantly different (2.6±1.7 vs. 2.2±1.3, p=0.5 and 2.5±1.8 vs. 2.5±1.8, p=0.9) respectively but we found a more pronounced reduction of the BASMI values in male patients after 12 months (Z=-5.0, p<0.001,) and 24 months (Z=-3.6, p<0.001) of treatment compared to female patients (Z=-1.8, p=0.075 and Z=-0.2, p=0.854 respectively). At 24 months, the mean improvement in BASMI score was significantly greater for male patients than for female patients (-1.0±1.2 vs. 0.1±0.6, p=0.033). Analogous results were not found considering BASDAI nor BASFI (p=0.892 and p=0.416) respectively.
Conclusions In patients with ax-SpA who were treated with anti-TNF, spinal mobility according to BASMI improved more in male than in female patients. Such gender association was not found for disease activity or function.
Lee W, et al. Ann Rheum Dis. 2007; 66(5):633-8.
Disclosure of Interest None declared