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World J Rheumatol. Nov 12, 2014; 4(3): 35-43
Published online Nov 12, 2014. doi: 10.5499/wjr.v4.i3.35
Gender differences in axial spondyloarthritis
Regula Neuenschwander, Adrian Ciurea
Regula Neuenschwander, Adrian Ciurea, Department of Rheumatology, University Hospital Zurich, 8091 Zurich, Switzerland
Author contributions: Neuenschwander R and Ciurea A were involved in drafting the article and revising it critically for important intellectual content and English language; Both authors approved the final version to be published.
Correspondence to: Adrian Ciurea, MD, Department of Rheumatology, University Hospital Zurich, Gloriastrasse 25, 8081 Zurich, Switzerland.
Telephone: +41-44-2552932 Fax: +41-44-2554415
Received: July 11, 2014
Revised: August 18, 2014
Accepted: September 18, 2014
Published online: November 12, 2014

Within the concept of axial spondyloarthritis (axSpA), relevant differences between men and women have been described for patients with the radiographic disease form [ankylosing spondylitis (AS)]. The subjective perception of disease activity (spinal and peripheral pain, fatigue, morning stiffness) has been shown to be higher in female than in male patients. Moreover, women experience more functional limitations and a lower quality of life, despite lower degrees of radiographic spinal damage. Peripheral clinical involvement (arthritis and enthesitis) is, additionally, more predominant in women. On the other hand, a higher level of objective signs of inflammation (C-reactive protein, erythrocyte sedimentation rate, magnetic resonance imaging of sacroiliac joints and spine) has been reported in men. Whether these differences might explain the better response to treatment with anti-tumor necrosis factor agents observed in male patients remains unclear. The underlying causes of the discrepancies are still unknown and genetic, environmental, cultural and/or societal factors may be involved. While AS is still more prevalent in men in a ratio of 2-3:1, the prevalence of males and females in patients with axSpA without radiographic sacroiliac damage is similar. Gender differences in this subgroup of patients have not been adequately addressed, and are particularly needed to further validate the Assessment of SpondyloArthritis international Society classification criteria.

Keywords: Axial spondyloarthritis, Ankylosing spondylitis, Classification, Gender, Outcome

Core tip: In comparison to men, women with ankylosing spondylitis (AS) experience a higher subjective burden of disease despite lower objective signs of systemic inflammation and less spinal radiographic damage. A better response to treatment with tumor necrosis factor inhibitors has been demonstrated in male AS patients.