Abstract
Introduction/objectivesTo evaluate the journey to diagnosis, disease characteristics and burden of disease in male and female patients with axial spondyloarthritis (axSpA) across Europe.MethodData from 2846 unselected patients participating in the European Map of Axial Spondyloarthritis (EMAS) study through an online survey (2017–2018) across 13 countries were analysed. Sociodemographic characteristics, lifestyle, diagnosis, disease characteristics and patient-reported outcomes (PROs) [disease activity –BASDAI (0–10), spinal stiffness (3–12), functional limitations (0–54) and psychological distress (GHQ-12)] were compared between males and females using chi-square (for categorical variables) and student t (for continuous variables) tests.ResultsIn total, 1100 (38.7%) males and 1746 (61.3%) females participated in the EMAS. Compared with males, females reported considerable longer diagnostic delay (6.1 ± 7.4 vs 8.2 ± 8.9 years; p < 0.001), higher number of visits to physiotherapists (34.5% vs 49.5%; p < 0.001) and to osteopaths (13.3% vs 24.4%; p < 0.001) before being diagnosed and lower frequency of HLA-B27 carriership (80.2% vs 66.7%; p < 0.001). In addition, females reported higher degree of disease activity in all BASDAI aspects and greater psychological distress through GHQ-12 (4.4 ± 4.2 vs 5.3 ± 4.1; p < 0.001), as well as a greater use of alternative therapies.ConclusionThe patient journey to diagnosis of axSpA is much longer and arduous in females, which may be related to physician bias and lower frequency of HLA-B27 carriership. Regarding PROs, females experience higher disease activity and poorer psychological health compared with males. These results reflect specific unmet needs in females with axSpA needing particular attention.Key Points• Healthcare professionals’ perception of axSpA as a predominantly male disease may introduce some bias during the diagnosis and management of the disease. However, evidence about male-female differences in axSpA is scarce.• EMAS results highlight how female axSpA patients report longer diagnostic delay and higher burden of the disease in a large sample of 2846 participants of 13 European countries.• Results reflect unmet needs of European female patients. Healthcare professionals should pay close attention in order to accurately diagnose and efficiently manage axSpA cases while further research should be developed on the cause of reported gender differences.
Highlights
Axial spondyloarthritis is an inflammatory chronic disease of insidious course characterised by recurrent episodes of pain and inflammation that mostly affect the spine and pelvis
The European Map of Axial Spondyloarthritis (EMAS) project is an international initiative promoted by the Axial Spondyloarthritis International Federation (ASIF) and the Spanish Federation of Spondyloarthritis Patient Associations (CEADE), led by the Health & Territory Research group of the University of Seville (HTR) and a steering committee composed of patient representatives and internationally recognised rheumatologists, psychologists and researchers specialised in axial spondyloarthritis (axSpA)
A total of 1100 (38.7%) males and 1746 (61.3%) females participated in the EMAS, with similar gender distribution across most countries (Fig. 2)
Summary
Axial spondyloarthritis (axSpA) is an inflammatory chronic disease of insidious course characterised by recurrent episodes of pain and inflammation that mostly affect the spine and pelvis. A recent meta-analysis showed that the diagnostic delay in axSpA is longer for females compared with males (8.8 vs 6.5 years) [3] The reasons for this difference are not completely understood. The results from this research seem to suggest a possible bias among physicians, who may think of axSpA only in male patients. This is understandable as historically, the estimated prevalence of axSpA was much higher in men than in women. Initial studies showed a male-female relationship of 10:1 [5, 6], but as research progressed, this gender difference was reduced to 3:1 [7, 8] and even 2:1 [9]. Healthcare professionals’ remaining perception of axSpA as a predominantly male disease may introduce some bias during the diagnosis and follow-up of the disease [3]
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