Psoriasis, psoriatic arthritis and risk of gout in US men and women

We thank Dr. Maguire et al1 for their interest in and appreciation of our study from the Corrona Psoriatic Arthritis/ Spondyloarthritis Registry comparing patient characteristics and disease burden between men and women with axial spondyloarthritis (axSpA).2 Dr. Maguire and colleagues raised a number of interesting questions around the causal relationship between the higher prevalence of depression and decreased work productivity we observed in women in our study.

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The Swedish Early Psoriatic Arthritis Registry 5-year Followup: Substantial Radiographic Progression Mainly in Men with High Disease Activity and Development of Dactylitis

The Journal of Rheumatology ◽

10.3899/jrheum.150165 ◽

2015 ◽

Vol 42 (11) ◽

pp. 2110-2117 ◽

Cited By ~ 31

Author(s):

Mats Geijer ◽

Ulla Lindqvist ◽

Tomas Husmark ◽

Gerd-Marie Alenius ◽

Per T. Larsson ◽

...

Keyword(s):

Psoriatic Arthritis ◽

Disease Activity ◽

Structural Damage ◽

Radiographic Progression ◽

Clinical Signs ◽

Tender Joint Count ◽

Radiographic Damage ◽

Radiographic Findings ◽

Men And Women ◽

Radiographic Score

Objective.To describe early radiographic findings in patients from the Swedish psoriatic arthritis (SwePsA) registry, progression of destruction, correlations with clinical disease variables, and predictors of destruction.Methods.Hand and foot radiographs were available for 72 of 197 SwePsA patients followed for 5 years. Clinical data were collected according to the SwePsA protocol.Results.Disease characteristics and clinical improvement were similar in men and women. Radiographic abnormalities were more pronounced in men. Total Wassenberg radiographic score at baseline was 0 in 45% of men and 51% of women. One man and one woman had a score > 10. At 5 years, total score was 0 in 14% of men and 40% of women (p = 0.018); 17% of men and 7% of women had scores > 10. Mean total scores for men and women had increased. Baseline erythrocyte sedimentation rate was associated with baseline total radiographic score. In men, swollen joint count was positively, and in women tender joint count negatively, correlated to total radiographic score. After 5 years, only male scores, mainly hand scores, significantly correlated with 28-joint Disease Activity Score and Disease Activity Index for Psoriatic Arthritis scores, swollen joint count, and dactylitis. Achieving remission or minimal disease activity after 5 years protected against structural damage, mainly in men.Conclusion.Radiographic progression in early PsA was generally slow but substantial. Male sex appears to be a risk factor for early radiographic damage while the presence of baseline radiographic damage and dactylitis developing during followup seem to predict further destruction. Hand and foot radiograph scoring cannot be substituted with clinical signs.

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Comparison of Men and Women With Axial Spondyloarthritis in the US-Based Corrona Psoriatic Arthritis/Spondyloarthritis Registry

The Journal of Rheumatology ◽

10.3899/jrheum.201549 ◽

2021 ◽

pp. jrheum.201549

Author(s):

Philip J. Mease ◽

Robert R. McLean ◽

Blessing Dube ◽

Mei Liu ◽

Sabrina Rebello ◽

...

Keyword(s):

Psoriatic Arthritis ◽

Ankylosing Spondylitis ◽

Disease Activity ◽

Disease Burden ◽

Axial Spondyloarthritis ◽

Categorical Variables ◽

Full Time ◽

Men And Women ◽

Patient Reported ◽

The Us

Objective To compare patient characteristics and disease burden between men and women with axial spondyloarthritis (axSpA) in the US-based Corrona Psoriatic Arthritis/Spondyloarthritis (PsA/SpA) Registry. Methods Patients aged ≥18 years with axSpA enrolled in the Corrona PsA/SpA Registry between March 2013 and November 2018 who were not concurrently diagnosed with PsA were included. Patient demographics, clinical characteristics, disease activity, patient-reported symptoms, work productivity, and treatment history at enrollment were compared between men and women using t tests or Wilcoxon rank-sum tests for continuous variables and χ2 or Fisher’s exact tests for categorical variables. Results Of 498 patients with axSpA and available sex information, 307 (61.6%) were men and 191 (38.4%) were women. Compared with men, women had higher disease activity as measured by Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Functional Index, and physician global assessment, and had higher tender/swollen joint counts and enthesitis scores (all P≤0.01). Women also had worse patient-reported symptoms (pain, fatigue, HAQ-S, and EQ-VAS; all P<0.05), greater work and activity impairment, and were less likely to work full time than men. Prior csDMARD and prednisone use was more common in women than in men (both P<0.05). Additionally, women were more likely to have diagnoses of depression and fibromyalgia (both P<0.01). Conclusion In this US registry of patients with axSpA, women had higher overall disease burden and more peripheral manifestations than men. Improved awareness of sex differences in the presentation of axSpA may aid physicians in earlier identification and improved disease management.

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Clinical Differences between Men and Women with Psoriatic Arthritis: Relevance of the Analysis of Genes and Polymorphisms in the Major Histocompatibility Complex Region and of the Age at Onset of Psoriasis

Clinical and Developmental Immunology ◽

10.1155/2013/482691 ◽

2013 ◽

Vol 2013 ◽

pp. 1-7 ◽

Cited By ~ 18

Author(s):

Rubén Queiro ◽

Patricia Tejón ◽

Pablo Coto ◽

Sara Alonso ◽

Mercedes Alperi ◽

...

Keyword(s):

Major Histocompatibility Complex ◽

Psoriatic Arthritis ◽

Age At Onset ◽

Joint Damage ◽

Joint Involvement ◽

Hormonal Changes ◽

Major Histocompatibility ◽

Genetic Associations ◽

Men And Women ◽

Histocompatibility Complex

It has been shown that males with spondyloarthritis tend to suffer from more severe spinal disease while females are more likely to have peripheral joint involvement. Nevertheless, gender-related differences have not been thoroughly explored in psoriatic arthritis (PsA). In PsA, males accumulate more peripheral and axial joint damage compared to women. However, it is not clear whether these findings are secondary to differences in occupational physical activity, hormonal changes, or other factors. The present study analyzed the differences in clinical expression of PsA between men and women. We have also evaluated the possible existence of gender-linked differences in the distribution of genes and polymorphisms within the major histocompatibility complex and whether patients’ age at the onset of psoriasis established any differences in these aspects. Women suffered more polyarthritis, greater functional impairment, and a larger number of swollen joints during followup. We appreciated a differential expression of certain MHC genes according to gender and age at onset of psoriasis. Our results point to the need to include patient’s age at the onset of psoriasis and gender as key stratification elements in future studies of genetic associations in PsA.

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OP0057 SEX SPECIFIC DIFFERENCES IN EARLY PSORIATIC ARTHRITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.3461 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 38-39

Author(s):

E. Passia ◽

M. Vis ◽

L. C. Coates ◽

A. Soni ◽

I. Tchetverikov ◽

...

Keyword(s):

Quality Of Life ◽

Psoriatic Arthritis ◽

Disease Activity ◽

First Year ◽

Research Support ◽

Men And Women ◽

Early Psoriatic Arthritis ◽

Over Time

Background:Although the prevalence of Psoriatic Arthritis (PsA) is the same in men and women, women experience a higher burden of disease (pain, disability, fatigue) (1).The persistent belief that women tend to over-report their symptoms compared to men may also contribute to under or delayed diagnosis in women. The clinical pattern of PsA also differs, with men presenting more commonly with peripheral and axial joint damage and women being affected more frequently by polyarthritis (2). Furthermore, most disease activity measures contain pain and quality of life measurement metrics that may perform differently by sex. As a result, this may affect the clinician’s perception of disease severity, influence management decisions and subsequently introduce sex bias in prescribing.Objectives:To assess sex-related differences in baseline demographics, disease characteristics and evolution over 1 year in patients with newly diagnosed PsA.Methods:Our study is embedded in the Dutch south-west Early Psoriatic Arthritis prospective cohort study. We described patient characteristics using simple descriptive analysis techniques. For the comparison across sexes and baseline and 1 year follow up, appropriate tests depending on the distribution were used.Results:273 men and 294 women with no significant differences in age and ethnicity were included. Women reported significantly longer duration of symptoms before diagnosis and significantly fewer of them were in paid employment at baseline. Oligoarthritis was the most common pattern of arthritis in both sexes. Polyarthritis and enthesitis were more prevalent in women who also presented at baseline a significantly higher tender joint count (Fig.1) than men but no difference in swollen joint count.Figure 1.Longitudinal evolution of TJC68, Pain, VAS global, BRAF for men and women in the first year of PsA.All composite indices (CPDAI, DAPSA, GRACE, MDA, Psoriatic ArthritiS Disease Activity Score) showed significantly worse results in women at baseline. Women also suffered more frequently from comorbid medical conditions, fatigue and anxiety, and reported more severe limitations in function and worse quality of life.At 12 months women, despite the improvement they made, reported significantly higher levels of pain compared to men. Although MDA rates increase over time for both sexes,(Fig.2), it remained significantly more prevalent among men (19.0% vs 11.1% at inclusion,p<0.05, and 58.1% vs 35.7%,p<0.00, at T12). DAPSA was significantly higher in women at both timepoints and a significantly higher percentage of men presented remission according to DAPSA score at 12 months.Figure 2.Longitudinal evolution of composite measures for men and women in the first year of PsA.Conclusion:After 1 year of follow-up women didn’t surpass their baseline disadvantages and despite the improvement, they still present higher disease activity, more pain and lower functional capacity than men. The nature of these findings may advocate a need for sex specific adjustment of treatment strategies and evaluation in psoriatic arthritis as sex-related difference in outcome persisted over time.References:[1]Eder L, Thavaneswaran A, Chandran V, Gladman DD. Gender difference in disease expression, radiographic damage and disability among patients with psoriatic arthritis. Annals of the rheumatic diseases. 2013;72(4):578-82.[2]Orbai AM, Perin J, Gorlier C, Coates LC, Kiltz U, Leung YY, et al. Determinants of Patient-Reported Psoriatic Arthritis Impact of Disease: An Analysis of the Association with Gender in 458 Patients from 14 Countries. Arthritis care & research. 2019.Disclosure of Interests:Evangelia Passia: None declared, Marijn Vis Grant/research support from: Novartis, Pfizer – grant/research support, Consultant of: AbbVie, Celgene Corporation, Eli Lilly, Novartis, Pfizer – consultant, Laura C Coates: None declared, Anushka Soni Grant/research support from: Oxford-UCB prize fellowship, Speakers bureau: Janssen and Abbvie, Ilja Tchetverikov: None declared, Andreas Gerards: None declared, Lindy-Anne Korswagen: None declared, Marc R Kok Grant/research support from: BMS and Novartis, Consultant of: Novartis and Galapagos, Wiebo van der Graaff: None declared, Josien Veris-van Dieren: None declared, Natasja Denissen: None declared, F. Fodili: None declared, M. Starmans: None declared, Yvonne Goekoop-Ruiterman: None declared, M. van Oosterhout: None declared, Jolanda Luime: None declared

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