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Gender differences in Iranian patients with ankylosing spondylitis

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Abstract

Inequalities in features and severity of ankylosing spondylitis (AS) have been noticed between men and women, suggesting a possible influence of gender on disease phenotypes. Comparing disease features and characterization of gender differences in clinical features and medications could help elucidate the potential influence of gender on the severity of AS in patients. This study aims to assess the influence of gender on disease patterns in Iranian patients with AS. Three hundred and twenty patients diagnosed with primary AS were assessed for demographic variables, clinical manifestations, HLA status, disease severity, functional capacities, quality of life, and treatment status. Sixty-seven women and 253 men were included corresponding to a male to female ratio of 3.78:1. Both groups were similar regarding ethnicity, positive family history, and juvenile onset AS. HLA-B27 was more frequent among males (78.3 vs. 55.2 %; p < 0.001). There was a higher proportion of female patients with overall enthesitis (p < 0.05). Extra-articular manifestations and treatment modalities presented similar frequencies in both genders. No difference in gender-associated diagnostic delays was observed. Female disease was at least as severe as male disease, and in some aspects, females presented with more severe disease. Despite a relatively similar disease profile, we observed a higher rate of enthesitis among women. Together with the equally high rate of disease activity indices in both genders, these findings indicate an overall longer delay to diagnosis in our country. Early detection and specialized care would be of great practical importance.

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References

  1. Lee W, Reveille JD, Davis JC Jr, Learch TJ, Ward MM, Weisman MH (2007) Are there gender differences in severity of ankylosing spondylitis? Results from the PSOAS cohort. Ann Rheum Dis 66(5):633–638

    Article  PubMed Central  PubMed  Google Scholar 

  2. Ankylosing Spondylitis Society in Iran. Ankylosing Spondylitis International Federation (ASIF). http://www.asif.rheumanet.org/iran.htm. Accessed December 24 2012

  3. van der Linden S, Valkenburg HA, Cats A (1984) Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 27(4):361–368

    Article  PubMed  Google Scholar 

  4. Feldtkeller E, Erlendsson J (2008) Definition of disease duration in ankylosing spondylitis. Rheumatol Int 28(7):693–696

    Article  PubMed  Google Scholar 

  5. van der Heijde D, van der Linden S, Bellamy N, Calin A, Dougados M, Khan MA (1999) Which domains should be included in a core set for endpoints in ankylosing spondylitis? Introduction to the ankylosing spondylitis module of OMERACT IV. J Rheumatol 26(4):945–947

    PubMed  Google Scholar 

  6. Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A (1994) A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol 21(12):2286–2291

    CAS  PubMed  Google Scholar 

  7. Calin A, Garrett S, Whitelock H, Kennedy LG, O'Hea J, Mallorie P, Jenkinson T (1994) A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index. J Rheumatol 21(12):2281–2285

    CAS  PubMed  Google Scholar 

  8. Jones SD, Porter J, Garrett SL, Kennedy LG, Whitelock H, Calin A (1995) A new scoring system for the Bath Ankylosing Spondylitis Metrology Index (BASMI). J Rheumatol 22(8):1609

    CAS  PubMed  Google Scholar 

  9. Jones SD, Steiner A, Garrett SL, Calin A (1996) The Bath Ankylosing Spondylitis Patient Global Score (BAS-G). Br J Rheumatol 35(1):66–71

    Article  CAS  PubMed  Google Scholar 

  10. Bidad K, Fallahi S, Mahmoudi M, Jamshidi A, Farhadi E, Meysamie A, Nicknam MH (2011) Evaluation of the Iranian versions of the bath ankylosing spondylitis disease activity index (BASDAI), the bath ankylosing spondylitis functional index (BASFI) and the patient acceptable symptom state (PASS) in patients with ankylosing spondylitis. Rheumatol Int 32:361–368

    Google Scholar 

  11. Doward LC, Spoorenberg A, Cook SA, Whalley D, Helliwell PS, Kay LJ, McKenna SP, Tennant A, van der Heijde D, Chamberlain MA (2003) Development of the ASQoL: a quality of life instrument specific to ankylosing spondylitis. Ann Rheum Dis 62(1):20–26

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  12. Marks SH, Barnett M, Calin A (1983) Ankylosing spondylitis in women and men: a case–control study. J Rheumatol 10(4):624–628

    CAS  PubMed  Google Scholar 

  13. Lee W, Reveille JD, Weisman MH (2008) Women with ankylosing spondylitis: a review. Arthritis Rheum 59(3):449–454

    Article  PubMed  Google Scholar 

  14. Will R, Edmunds L, Elswood J, Calin A (1990) Is there sexual inequality in ankylosing spondylitis? A study of 498 women and 1202 men. J Rheumatol 17(12):1649–1652

    CAS  PubMed  Google Scholar 

  15. Nazarinia MA, Ghaffarpasand F, Heiran HR, Habibagahi Z (2009) Pattern of ankylosing spondylitis in an Iranian population of 98 patients. Mod Rheumatol 19(3):309–315

    Article  PubMed  Google Scholar 

  16. Bodur H, Ataman S, Bugdayci DS, Rezvani A, Nas K, Uzunca K, Emlakcioglu E, Karatepe AG, Durmus B, Sezgin M, Ayhan F, Yazgan P, Duruoz T, Yener M, Gurgan A, Kirnap M, Cakar E, Altan L, Soydemir R, Capkin E, Tekeoglu I, Aydin G, Gunendi Z, Nacir B, Salli A, Ozturk C, Memis A, Turan Y, Kozanoglu E, Sivrioglu K (2012) Description of the registry of patients with ankylosing spondylitis in Turkey: TRASD-IP. Rheumatol Int 32(1):169–176

    Article  PubMed  Google Scholar 

  17. Lee CH, Lee MS, Kang KY, Mun SJ, Kim JM, Yun HS, Kwak SG, Ju JH, Park KS, Kim H-Y, Park S-H (2012) Gender differences in clinical features and anti-TNF agent use in Korean ankylosing spondylitis patients. J Rheum Dis 19(3):132–137

    Article  Google Scholar 

  18. Aggarwal R, Malaviya AN (2009) Clinical characteristics of patients with ankylosing spondylitis in India. Clin Rheumatol 28(10):1199–1205

    Article  PubMed  Google Scholar 

  19. Zeng QY (2003) Ankylosing spondylitis in Shantou, China: 15 years' clinical experience. J Rheumatol 30(8):1816–1821

    PubMed  Google Scholar 

  20. Vliet Vlieland TP, Buitenhuis NA, van Zeben D, Vandenbroucke JP, Breedveld FC, Hazes JM (1994) Sociodemographic factors and the outcome of rheumatoid arthritis in young women. Ann Rheum Dis 53(12):803–806

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  21. Salaffi F, Carotti M, Gasparini S, Intorcia M, Grassi W (2009) The health-related quality of life in rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis: a comparison with a selected sample of healthy people. Health Qual Life Outcomes 7:25

    Article  PubMed Central  PubMed  Google Scholar 

  22. Dernis E, Said-Nahal R, D'Agostino MA, Aegerter P, Dougados M, Breban M (2009) Recurrence of spondylarthropathy among first-degree relatives of patients: a systematic cross-sectional study. Ann Rheum Dis 68(4):502–507

    Article  CAS  PubMed  Google Scholar 

  23. Stone M, Warren RW, Bruckel J, Cooper D, Cortinovis D, Inman RD (2005) Juvenile-onset ankylosing spondylitis is associated with worse functional outcomes than adult-onset ankylosing spondylitis. Arthritis Rheum 53(3):445–451

    Article  PubMed  Google Scholar 

  24. Robinson PC, Brown MA (2012) The genetics of ankylosing spondylitis and axial spondyloarthritis. Rheum Dis Clin N Am 38(3):539–553

    Article  Google Scholar 

  25. Hill HF, Hill AG, Bodmer JG (1976) Clinical diagnosis of ankylosing spondylitis in women and relation to presence of HLA-B27. Ann Rheum Dis 35(3):267–270

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  26. de Carvalho HM, Bortoluzzo AB, Goncalves CR, da Silva JA, Ximenes AC, Bertolo MB, Ribeiro SL, Keiserman M, Menin R, Skare TL, Carneiro S, Azevedo VF, Vieira WP, Albuquerque EN, Bianchi WA, Bonfiglioli R, Campanholo C, Costa IP, Duarte AP, Gavi MB, Kohem CL, Leite NH, Lima SA, Meirelles ES, Pereira IA, Pinheiro MM, Polito E, Resende GG, Rocha FA, Santiago MB, Sauma Mde F, Sampaio-Barros PD (2012) Gender characterization in a large series of Brazilian patients with spondyloarthritis. Clin Rheumatol 31(4):687–695

    Article  PubMed  Google Scholar 

  27. Singh G, Lawrence A, Agarwal V, Misra R, Aggarwal A (2008) Higher prevalence of extra-articular manifestations in ankylosing spondylitis with peripheral arthritis. J Clin Rheumatol 14(5):264–266

    Article  PubMed  Google Scholar 

  28. Zeboulon N, Dougados M, Gossec L (2008) Prevalence and characteristics of uveitis in the spondyloarthropathies: a systematic literature review. Ann Rheum Dis 67(7):955–959

    Article  CAS  PubMed  Google Scholar 

  29. Linder R, Hoffmann A, Brunner R (2004) Prevalence of the spondyloarthritides in patients with uveitis. J Rheumatol 31(11):2226–2229

    PubMed  Google Scholar 

  30. Tay-Kearney ML, Schwam BL, Lowder C, Dunn JP, Meisler DM, Vitale S, Jabs DA (1996) Clinical features and associated systemic diseases of HLA-B27 uveitis. Am J Ophthalmol 121(1):47–56

    Article  CAS  PubMed  Google Scholar 

  31. Calin A, Elswood J, Rigg S, Skevington SM (1988) Ankylosing spondylitis–an analytical review of 1500 patients: the changing pattern of disease. J Rheumatol 15(8):1234–1238

    CAS  PubMed  Google Scholar 

  32. Zochling J (2011) Measures of symptoms and disease status in ankylosing spondylitis: Ankylosing Spondylitis Disease Activity Score (ASDAS), Ankylosing Spondylitis Quality of Life Scale (ASQoL), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Global Score (BAS-G), Bath Ankylosing Spondylitis Metrology Index (BASMI), Dougados Functional Index (DFI), and Health Assessment Questionnaire for the Spondylarthropathies (HAQ-S). Arthritis Care Res (Hoboken) 63(Suppl 11):S47–S58

    Article  Google Scholar 

  33. Jimenez-Balderas FJ, Mintz G (1993) Ankylosing spondylitis: clinical course in women and men. J Rheumatol 20(12):2069–2072

    CAS  PubMed  Google Scholar 

  34. Ibn Yacoub Y, Amine B, Laatiris A, Hajjaj-Hassouni N (2012) Gender and disease features in Moroccan patients with ankylosing spondylitis. Clin Rheumatol 31(2):293–297

    Article  PubMed  Google Scholar 

  35. Jung YO, Kim I, Kim S, Suh CH, Park HJ, Park W, Kwon SR, Jeong JC, Lee YJ, Ryu HJ, Park YB, Lee J, Lee YH, Seo YI, Chung WT, Hong SJ, Hong YS, Baek HJ, Choi HJ, Kang HJ, Lee CH, Kim SH, Kim HA (2010) Clinical and radiographic features of adult-onset ankylosing spondylitis in Korean patients: comparisons between males and females. J Korean Med Sci 25(4):532–535

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported by a grant from Tehran University of Medical Sciences (TUMS), Tehran, Iran. We thank the Rheumatology Research Center and Iranian AS society for their valuable collaborations.

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Authors and Affiliations

  1. Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, P.O. Box 1411713137, Kargar Ave., Tehran, Iran

    Abtin Shahlaee, Mahdi Mahmoudi, Sasan Fallahi & Ahmad Reza Jamshidi

  2. Molecular Immunology Research Center, Tehran University of Medical Sciences, Tehran, Iran

    Mahdi Mahmoudi & Mohammad Hossein Nicknam

  3. Hematology Department, School of Allied Medical Science, Tehran University of Medical Sciences, Tehran, Iran

    Elham Farhadi

  4. Internal Medicine Division, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran

    Sasan Fallahi

  5. Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran

    Abtin Shahlaee

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  1. Abtin Shahlaee
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  2. Mahdi Mahmoudi
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  3. Mohammad Hossein Nicknam
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  4. Elham Farhadi
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  5. Sasan Fallahi
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  6. Ahmad Reza Jamshidi
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Correspondence to Ahmad Reza Jamshidi.

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Shahlaee, A., Mahmoudi, M., Nicknam, M.H. et al. Gender differences in Iranian patients with ankylosing spondylitis. Clin Rheumatol 34, 285–293 (2015). https://doi.org/10.1007/s10067-013-2439-4

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  • DOI: https://doi.org/10.1007/s10067-013-2439-4

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