Clinical and instrumental characteristics of psoriatic arthritis in men and women. Data from a cohort observational study

Abstract

Aim. To study and compare the clinical and imaging characteristics of psoriatic arthritis (PsA) in men and women. Materials and methods. The study included 956 PsA patients observed in the Russian register, 411 (43%) men and 545 (57%) women. The average age of men/women was 46.0±16.50/50.7±17.20 years (p0.001), the duration of PsA was 9.9±6.4/10.3±7.6 years (p0.05), the age at the time of PsA establishment was 37.1±12.30/41.8±13.5 years (p0.001). Rheumatological examination, X-ray of the pelvis, hands, feet were performed, the LEI, plantar fascia tenderness, body surface area (BSA), body mass index (BMI), CRP, HLA-B27 were determined. Patients filled out assessment scales of pain (Pain), disease activity (patient global assessment of disease activity – PGA), questionnaires HAQ-DI. The indices of Disease Activity in PSoriatic Arthritis (DAPSA), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), criteria of minimal disease activity (MDA) were evaluated. Results. The following differences in the course of PsA in men/women were revealed: X-ray sacroiliitis was detected in 175 (42.6%)/153 (28.1%); p0.001; the presence of erosions of the joints of the hands and feet – 138 (33.6%)/170 (31.2%); p=0.435; LEI≥3 – 34 (11.4%)/78 (20.9%); p=0.001; Pain – at 48.5±22.60/51.5±22.80 mm VAS; p=0.043; PGA – 50.2±23.07/54.0±21.91 mm VAS; p=0.010; moderate and severe functional disorders (HAQ-DI) were more often observed in women (p=0.002 and p0.001, respectively); the average value of DAPSA is 26.4±16.8/31.9±22.58; p0.001; average BASDAI value: 2.7±2.83/1.8±2.78; p0.001; MDA was achieved in 13 (3.2%)/22 (4.1%); p=0.486; BSA10% – 54 (13.1%)/102 (18.7%); p=0.021; comorbid diseases – 154 (37%)/277 (51%); p0.001. At the time of inclusion in the register, the proportion of patients receiving biologic disease-modifying anti-rheumatic drugs was higher in the group of men. Conclusion. Our data, based on a large cohort study, demonstrate that PsA debuts in women at a later age than in men, the course of the disease is characterized by higher activity of peripheral arthritis, more pronounced functional disorders and a high prevalence of comorbid diseases. This creates a heavier burden of PsA in women and indicates that gender is an important characteristic of the patient that should be used to predict the course, therapeutic response and progression of the disease.

Keywords

• psoriatic arthritis
• gender differences
• cohort study