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Time to consider gender stratification in AxSpA diagnosis and management

Jun 07, 2022 9:56 am

Differences across genders in many aspects related to rheumatic diseases diagnosis, phenotyping, trajectories definition and prediction of response to treatment have been overlooked. Two abstracts have shed light on relevant gender-based differences in AxSpA assessment or treatment.

First, in OP0073, Ulas and colleagues have interrogated gender-specific assessment of MRI imaging criteria in 684 patients. They observed a lower prevalence for ankylosis (7.4 vs. 24.3%) and fat metaplasia (42.6 vs. 58.8%) in females axSpA patients; while sclerosis was more common (75.0 vs. 57.6%). They observed no particular difference for other parameters such as bone marrow oedema and erosion. Moreover, in male AxSpA, ankylosis showed the most significant difference in individual parameters with a diagnostic odd ratio (DOR) of 40 compared with females (DOR 4.7). The detection of other parameters such as erosion and fat metaplasia was also better in male AxSpA patients.

In addition, gender seems to have an impact on treatment response. In OP0020, Hellamand and colleagues assessed gender differences in effectiveness of TNFi in bionaive pts using data from the EUROSPA research Collaboration network.

A total of 6,451 AxSpA patients were assessed for treatment response. The authors found that the probability for females to have a clinically important improvement was 15% lower than males (RR 0.85; 95CI 0.82-0.89). In addition, the retention rates of TNFi were significantly lower at 6, 12 and 24-months in females (81%/69%/58%) compared to males (89%/81%/72%).

Overall, diagnostic accuracy and diagnostic performances of common imaging markers seem to be reduced in female AxSpA patients and response to first TNFi is significantly better in male AxSpA patients. This highlights the need for gender specific imaging criteria in AxSpA and supports the development of therapeutic strategies stratified by gender.

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