Gender difference in ASAS HI among patients with ankylosing spondylitis.

Hsin-Hua Chen,Yin-Yi Chou,Kuo-Lung Lai,Yi-Da Wu,Chin-Yin Huang,Wei-Ting Hung,Tsu-Yi Hsieh,Chih-Wei Tseng,Kuo-Tung Tang,Yi-Hsing Chen,Ching-Tsai Lin,Chia-Wei Hsieh,Wen-Nan Huang,Yi-Ming Chen,Antony Nicodemus Antoniou

doi:10.1371/journal.pone.0235678

Abstract

To assess the associations of the Assessment of Spondyloarthritis International Society Health Index (ASAS HI) with gender and other factors in patients with ankylosing spondylitis (AS). From November 2017 to October 2018, we measured the Ankylosing Spondylitis Disease Activity Score (ASDAS), the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI), the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) and the ASAS HI score for AS patients at the Taichung Veterans General Hospital. After adjusting for disease activity (ASDAS-erythrocyte sedimentation rate [ESR], ASDAS- C-reactive protein [CRP], BASDAI+ESR or BASDAI+CRP), mSASSS and other potential confounders including medications, comorbidities, and laboratory data, any associations between gender and the sum score of ASDAS HI were assessed using multiple linear regression analysis, as well as any associations between gender and an ASAS HI score >5 using multivariable logistic regression analysis. A total of 307 AS patients (62 [20.2%] females, mean age 46.4 years [S.D. 13.3], mean symptom duration 20.6 years [S.D. 12.1]) were included. Multiple linear regression analysis showed that the male gender was significantly associated with a lower ASAS HI (B = -1. 91, 95% confidence interval [CI], -2.82--1.00, p <0.001). Multivariable logistic regression analysis revealed that males also had a lower risk of achieving scores of ASAS HI > 5 than females (odds ratio = 0.15, 95% CI, 0.07-0.36, p <0.001). Disease activity measures, including ASDAS-ESR, ASDAS-CRP and BASDAI, had positive correlations with ASAS HI. This single-center, cross-sectional study revealed that a higher ASAS HI score was significantly associated with female gender and higher disease activity measures.

Highlights

Ankylosing spondylitis (AS) is a common chronic inflammatory rheumatic disease, which mainly affecting the axial skeleton, but can affect peripheral joint and entheses [1]
Multiple linear regression analysis showed that the male gender was significantly associated with a lower Assessment of Spondyloarthritis International Society Health Index (ASAS HI) (B = -1. 91, 95% confidence interval [confidence intervals (CIs)], −2.82–−1.00, p
AS has been thought to be a variety of spondyloarthritis (SpA), which is associated with other extra-articular manifestations (EAMs) including uveitis, psoriasis, and inflammatory bowel disease

Summary

Introduction

Ankylosing spondylitis (AS) is a common chronic inflammatory rheumatic disease, which mainly affecting the axial skeleton, but can affect peripheral joint and entheses [1] It has a prevalence rate between 0.11% and 0.38% in Taiwan [2, 3]. With respect to AS-related clinical outcomes, prior studies showed that females had worse outcomes with regards to Bath AS Disease Activity Index (BASDAI), of which total back pain and longer morning stiffness duration showing the largest difference [19, 22,23,24], function [19, 25], QoL [24,25,26,27], and overall well-being in daily life indicated by Bath Ankylosing Spondylitis Global scores. Men had worse radiographic spinal progression compared to women [15, 16, 21, 27, 30,31,32]

Methods

Results

Discussion

Conclusion