Abstract
BackgroundIn patients with axial spondyloarthritis (axSpA), magnetic resonance imaging (MRI) is used to detect bone marrow edema (BME) in sacroiliac joints (SIJ) but SIJ BME are also detected in the population. Not much is known about sex differences in that regard.ObjectiveTo explore sex-specific differences associated with the extent of BME in the SIJ suggestive of axSpA in a general population cohort study.MethodsTaking advantage of 793 recently evaluated MRIs of subjects < 45 years taking part in the SHIP cohort, we used negative-binomial (NB) count data regression to analyze factors associated with the extent of SIJ BME. Predictors were explored by model-based boosting (MBB), a machine learning approach.ResultsEstimates of NB regression showed strong effects of sex in interaction with age, BMI, back pain, and particularly HLA-B27. The NB regression model showed incidence rate ratios (IRR) for the main effect of sex (females vs. males): 0.94 [95% CI: 0.63; 1.41], HLA-B27: 4.32 [2.09; 9.8], and for the interaction of sex to HLA-B27: 0.22 [0.06; 0.75]. According to MBB, HLA-B27 positivity, BMI, current smoking, back pain in the last 3 months, the interaction of sex and HLA-B27, and delivery in the last 12 months were of highest importance to explain the extent of SIJ BME.ConclusionsDifferent factors were associated with the extent of SIJ BME in females and males. Most importantly, HLA-B27 was relevant only in males but not in females in whom a postpartal state was important. This finding may be relevant for the pathogenesis of axSpA.
Highlights
While ankylosing spondylitis (AS) had been widely recognized as a male disease [1], this is different in axial spondyloarthritis, where the male/female ratio is more or less equal [2], and especially in patients with non-radiographic axSpA, where the proportion of women is even higher [3]
Different factors were associated with the extent of sacroiliac joints (SIJ) bone marrow edema (BME) in females and males
Key messages The main result of this cohort study is that the extent of lesions in the sacroiliac joints detected by magnetic resonance imaging (MRI) in a young population < 45 years is influenced by HLA B27, an MHC class I allele which is strongly associated with axial spondyloarthritis—only in males
Summary
While ankylosing spondylitis (AS) had been widely recognized as a male disease [1], this is different in axial spondyloarthritis (axSpA), where the male/female ratio is more or less equal [2], and especially in patients with non-radiographic axSpA (nr-axSpA), where the proportion of women is even higher [3]. Using data of 793 subjects aged
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