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Gender-related differences in disease activity and clinical features in patients with peripheral psoriatic arthritis: A multi-center study - 05/06/21

Doi : 10.1016/j.jbspin.2021.105177 
Mehmet Tuncay Duruöz a, Halise Hande Gezer a, , Kemal Nas b, Erkan Kılıç c, Betül Sargın d, Sevtap Acer Kasman a, Hakan Alkan e, Nilay Şahin f, Gizem Cengiz g, Nihan Cüzdan h, İlknur Albayrak Gezer i, Dilek Keskin j, Cevriye Mülkoğlu k, Hatice Reşorlu l, Şebnem Ataman m, Ajda Bal n, Okan Küçükakkaş o, Ozan Volkan Yurdakul o, Meltem Alkan Melikoğlu p, Merve Baykul q, Fikriye Figen Ayhan r, Hatice Bodur s, Mustafa Çalış t, Erhan Çapkın u, Gül Devrimsel v, Kevser Gök w, Sami Hizmetli x, Ayhan Kamanlı b, Yaşar Keskin p, Hilal Ecesoy y, Öznur Kutluk z, Nesrin Şen aa, Ömer Faruk Şendur ab, İbrahim Tekeoğlu b, Sena Tolu ac, Murat Toprak ad, Tiraje Tuncer z
a Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine, İstanbul, Turkey 
b Division of Rheumatology and Immunology, Department of Physical Medicine and Rehabilitation, Sakarya University School of Medicine, Sakarya, Turkey 
c Kanuni Training and Research Hospital; Rheumatology Clinic, Trabzon, Turkey 
d Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Adnan Menderes University School of Medicine, Aydın, Turkey 
e Department of Physical Medicine and Rehabilitation, Pamukkale University School of Medicine, Denizli, Turkey 
f Department of Physical Medicine and Rehabilitation, Balıkesir University School of Medicine, Balıkesir, Turkey 
g Van Training and Research Hospital; Rheumatology Clinic, Van, Turkey 
h Balıkesir Atatürk City Hospital, Rheumatology Clinic, Balıkesir, Turkey 
i Department of Physical Medicine and Rehabilitation, Selçuk University School of Medicine, Konya, Turkey 
j Department of Physical Medicine and Rehabilitation, Kırıkkale University School of Medicine, Kırıkkale, Turkey 
k Department of Physical Medicine and Rehabilitation, Ankara Training and Research Hospital, Ankara, Turkey 
l Department of Physical Medicine and Rehabilitation, Çanakkale Onsekiz Mart University School of Medicine, Çanakkale, Turkey 
m Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Ankara University School of Medicine, Ankara, Turkey 
n Department of Physical Medicine and Rehabilitation, University of Health Sciences Ankara Dışkapı Yıldırım Beyazıt Trainig and Research Hospital, Ankara, Turkey 
o Department of Physical Medicine and Rehabilitation, Bezmiâlem Foundation University, İstanbul, Turkey 
p Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Atatürk University School of Medicine, Erzurum, Turkey 
q Department of Physical Medicine and Rehabilitation, Sakarya University School of Medicine, Sakarya, Turkey 
r Department of Physical Medicine and Rehabilitation, Atilim University Medical School, Ankara, Turkey 
s Department of Physical Medicine and Rehabilitation, Yıldırım Beyazıt University School of Medicine, Ankara, Turkey 
t Division of Rheumatology, Department of Physical Medicine and Rehabilitation, School of Medicine, Erciyes University, Kayseri, Turkey 
u Department of Physical Medicine and Rehabilitation, Karadeniz Technical University School of Medicine, Trabzon, Turkey 
v Department of Physical Medicine and Rehabilitation, Recep Tayyip Erdoğan University School of Medicine, Rize, Turkey 
w Ankara City Hospital; Rheumatology Clinic, Ankara, Turkey 
x Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Cumhuriyet University School of Medicine, Sivas, Turkey 
y Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Necmettin Erbakan University Meram School of Medicine, Konya, Turkey 
z Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Akdeniz University School of Medicine, Antalya, Turkey 
aa Kartal Dr. Lutfi Kirdar Training and Research Hospital, Rheumatology Clinic, İstanbul, Turkey 
ab Department of Physical Medicine and Rehabilitation, Adnan Menderes University School of Medicine, Aydın, Turkey 
ac Department of Physical Medicine and Rehabilitation, Medipol University School of Medicine, İstanbul, Turkey 
ad Department of Physical Medicine and Rehabilitation, Yuzuncu Yıl University School of Medicine, Van, Turkey 

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Highlights

Female patients with peripheral PsA have lower remission and MDA rates and higher levels of disease activity than males.
Female patients experience a more severe course of PsA, with higher levels of pain and fatigue, lower quality of life, and increased functional limitations.
The predictors of MDA are similar between genders in patients with peripheral PsA.

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Abstract

Objective

This study sought to compare disease activity, clinical features, and patient-reported outcomes concerning anxiety, depression, fatigue, function, quality of life, and fibromyalgia between female and male patients with peripheral PsA in a Turkish population.

Methods

This multi-center Turkish League Against Rheumatism (TLAR) Network study included 1038 patients (678 females, 360 males) diagnosed with peripheral PsA according to the CASPAR criteria. The demographic and clinic parameters of the patients were recorded. Disease activity was evaluated using the scores of DAS28 and cDAPSA. Remission, minimal disease activity (MDA), and very low disease activity (VLDA) were determined. Health Assessment Questionnaire (HAQ), Short-Form-36 (SF-36), Hospital Anxiety and Depression Scale (HAD), fatigue VAS (0–10), and Fibromyalgia Rapid ScreeningTool (FiRST) were used. Disease activity and patient-reported outcomes were compared in male and female patients, and the predictors of MDA for both genders were analyzed.

Results

The patients’ mean age was 47.6years (SD: 12) for females and 46.3years (SD: 12.3) for males. In terms of DAS28 and cDAPSA, female patients had significantly higher disease activity scores, while male patients had significantly higher remission rates (P<0.05). There was a significant difference in the rate of MDA in favor of males (P<0.05), but not in VLDA. The incidences of dactylitis, enthesitis, tenosynovitis, and inflammatory bowel disease were similar in male and female patients, except for spondylitis, which was higher in males (P<0.05). Overall, although there was no significant between-group difference in age and disease duration, female patients had significantly higher BMI and late-onset disease (P<0.05). Female patients had higher HAD, HAQ, and FiRST and lower SF-36 scores than males (P<0.05). In both male and female patients, the disease activity score of cDAPSA was significantly correlated with the scores of FiRST, HAD, VAS-F, and HAQ (P<0.05). In regression analysis, tender joint count, swollen joint count, PASI, pain VAS, and enthesitis were the MDA predictors in both genders.

Conclusion

In patients with peripheral PsA, males are more likely to develop spondylitis while other extraarticular manifestations are similar. Female patients appear to have lower rates of remission and MDA and higher levels of disease activity. Female patients experience a more severe course of PsA, with higher levels of pain and fatigue, lower quality of life, and increased functional limitations. The predictors of MDA, i.e., tender joint count, swollen joint count, PASI, pain VAS, and enthesitis are similar between the two genders.

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Keywords : Psoriatic arthritis, Gender characteristics, Sex, Women's health


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Vol 88 - N° 4

Article 105177- juillet 2021 Retour au numéro
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