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Review
. 2020 Aug;50(4):687-694.
doi: 10.1016/j.semarthrit.2020.05.005. Epub 2020 May 25.

Understanding differences between men and women with axial spondyloarthritis

Grace C Wright  1 , Jeffrey Kaine  2 , Atul Deodhar  3
Affiliations
Free article
Review

Understanding differences between men and women with axial spondyloarthritis

Grace C Wright et al. Semin Arthritis Rheum. 2020 Aug.
Free article

Abstract

Axial spondyloarthritis (axSpA) is a chronic inflammatory immune-mediated disease resulting in inflammatory low back pain and other inflammatory manifestations in peripheral joints and entheses. AxSpA encompasses both ankylosing spondylitis (AS), in which patients present with definitive sacroiliitis visible on radiographic imaging, as well as nonradiographic axSpA (nr-axSpA), in which such changes may not be discernable. Emerging evidence suggests that women and men experience axSpA differently. Although the prevalence of AS is approximately 2- to 3- fold higher in men than in women, nr-axSpA occurs with roughly equal frequency in women and men. The goal of this review is to increase awareness of sex differences in axSpA by exploring the distinct manifestations of disease and disease characteristics in women, the overall clinical burden, recommendations for diagnosis, and potential treatment options. We summarize and contextualize the results of recent studies that illuminate sex differences in nr-axSpA and AS, including differences in disease manifestation and progression. It is important that sex differences in axSpA are understood and considered when diagnosing and treating the spectrum of axSpA, including AS and nr-axSpA.

Keywords: Ankylosing spondylitis; Nonradiographic axial spondyloarthritis; Sex; Sex differences; Spondyloarthritis; Women's health.

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Conflict of interest statement

Declaration of Competing Interest GCW has received consulting fees from AbbVie, Amgen, Bristol-Myers Squibb, Eli Lilly, Exagen, Gilead, Janssen, Myriad Autoimmune, Novartis, Pfizer, Sanofi Genzyme Regeneron, and UCB; has served as a continuing medical education consultant speaker for Vindico; has served as a speaker for AbbVie, Amgen, Bristol-Myers Squibb, Eli Lilly, Exagen, Myriad Autoimmune, Novartis, Sanofi Genzyme Regeneron, and UCB; and is the President and Founder of the Association of Women in Rheumatology. JK has received consulting fees from AbbVie, Eli Lilly, Gilead, Novartis, and Pfizer and has served as a speaker for Bristol-Myers Squibb, Eli Lilly, Merck, Novartis, and Pfizer. AD has received research grants from AbbVie, Eli Lilly, GSK, Novartis, Pfizer, and UCB and has received consulting fees from AbbVie, Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, GSK, Janssen, Novartis, Pfizer, and UCB.

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