Psoriatic arthritis affects women more than men

Women with psoriatic arthritis (PsA) experience a higher burden of disease than men in terms of pain, disability and quality of life, based on data from a cross-sectional survey of more than 2,000 people and their rheumatologists and dermatologists.

Although men and women are equally affected by PsA, previous research suggests gender differences in clinical manifestations that can manifest in many ways, including quality of life, but data on gender differences in PsA are limited, wrote Dr. Laure Gossec from the Pitié-Salpêtrière Hospital and Sorbonne University, Paris, and colleagues.

In a study published in the Journal of Rheumatology, researchers conducted a cross-sectional survey of rheumatologists and dermatologists and their patients with PsA from June to August 2018. The study population included 2,270 adults from France, Germany, Italy, Spain and the United Kingdom and United States. The mean age of the patients was 48.6 years, the mean disease duration was 4.9 years, and 46% (1,047 patients) were women.

The survey data included information on demographics, treatment, and clinical characteristics such as B. Number of tender and swollen joints and body surface affected by psoriasis. Researchers assessed quality of life on survey using the 5-dimensional EuroQoL questionnaire (EQ-5D) and disease impact using the 12-item Psoriatic Arthritis Impact of Disease (PsAID12). They assessed patients’ disability and work productivity using the Health Assessment Questionnaire–Disability Index (HAQ-DI) and the Work Productivity and Impairment Questionnaire (WPAI).

The general clinical picture, duration and use of biologics were similar in males and females. However, women reported a significantly poorer quality of life compared to men, with a mean EQ-5D score of 0.80 vs. 0.82 (P = 0.02).

Women also performed better than men on measures of disability and work impairment, with mean HAQ-DI scores of 0.56 vs. 0.41 and mean WPAI scores of 27.9% vs. 24.6% (P < 0.01).

Based on PsAID12 scores (2.66 vs. 2.27), the burden of disease was significantly higher in women than in men, and women reported significantly higher levels of fatigue and pain (P < 0.01 for all).

More men than women reported working full-time (68.6% vs. 49.4%), but there were no gender differences in missed work hours due to PsA, the researchers found.

However, women had significantly fewer comorbidities compared to men based on the Charlson Comorbidity Index (1.10 vs. 1.15, P < 0.01).

“Other factors not assessed in the study likely contribute to disease burden, and these unmeasured factors may affect males and females differently,” the researchers wrote in their discussion. Those factors can include hormone levels and treatment outcomes, as well as sleep disorders, anxiety and joint erosion, they said.

The study results were limited by several factors, including the possible overrepresentation of patients who saw doctors more frequently, the use of self-reports and possible recall bias, and the lack of data on fibromyalgia prevalence using a validated score, the researchers noted. However, the results were bolstered by the large and geographically diverse study population and underscore the need for further research to investigate the additional disease burden of PsA in women and the potential of alternative treatment regimens to improve the management of PsA in women, they concluded.

Mechanisms driving sex differences remain unclear

dr Dafna D Gladman

“Over the past few decades, there has been increasing interest in the effect of gender on the manifestations and effects of PsA, as well as response to therapy,” said Dafna D. Gladman, MD, of the University of Toronto and Krembil Research Institute at Toronto Western Hospital, wrote in an accompanying editorial.

The current study results support previous research showing differences in disease expression in PsA between men and women, Gladman said. Several studies have shown more axial disease and joint damage in men than in women, while women reported greater functional disability and poorer quality of life than men. The reasons for gender differences remain unclear, and genetics may also play a role, she said.

Gladman stressed the need for more research specifically into the effects of fibromyalgia (FM). “As shown in a previous study, the presence of FM influences the clinical assessment of patients with PsA,” she wrote. Fibromyalgia and pain reports may also impact clinical trials of patients with PsA; However, the effect of fibromyalgia on gender differences is uncertain, she said. “With a disease that affects males and females equally, it is important to recognize the gender effect,” and more research is needed to explore the mechanisms behind this effect, she concluded.

The study was supported by Janssen Research & Development. Gossec announced it has received research grants and/or consulting fees from Janssen and 13 other pharmaceutical companies. Several of the study’s co-authors have disclosed affiliations with several companies, and several of the co-authors are employees and shareholders of Janssen. Gladman had no financial conflicts to disclose.

This article originally appeared on MDedge.com, part of the Medscape Professional Network.