Sex-associated and gender-associated differences in the diagnosis and management of axial spondyloarthritis: addressing the unmet needs of female patients - Université de Versailles Saint-Quentin-en-Yvelines
Journal Articles RMD Open Year : 2021

Sex-associated and gender-associated differences in the diagnosis and management of axial spondyloarthritis: addressing the unmet needs of female patients

Maria-Sole Chimenti
Rieke Alten
Elisa Gremese
Uta Kiltz
Ennio Lubrano
Mireia Moreno
Thao Pham
Roberta Ramonda
Francesca-Romana Spinelli
Chiara Perella
  • Function : Author
Laura Andreoli

Abstract

Emerging evidence suggests that axial spondyloarthritis (axSpA) should not be seen as a predominantly male disease, as the non-radiographic form occurs with roughly equal frequency in women and men. However, men and women experience this disease differently. The purpose of this review is to highlight sex-associated and gender-associated differences in the patient’s journey through the diagnosis and management of axSpA, in order to increase the awareness about the unmet needs of female axSpA patients. Female patients experience a longer diagnostic delay compared with men, possibly due to the different pattern of clinical presentations across genders. Therefore, it is crucial to sensitise physicians to pay attention and identify the red flags of axSpA in women and promote early referral to a rheumatologist. Women with a diagnosis of axSpA experience greater limitations in physical function, although they have less structural spinal damage compared with men. Women tend to have less adherence and a lower response to treatment, so more gender-oriented data are needed about drugs used for axSpA, especially biological disease-modifying antirheumatic drugs. Lifestyle factors have a strong impact on the disease course. Interventions regarding physical activity, smoking cessation and diet should be communicated to the patients, with particular attention to the gender-related cultural background. Patients of childbearing age living with axSpA should be engaged in a discussion about reproductive health, in terms of preservation of fertility, management of pregnancy and delivery and use of biologic drugs during pregnancy and breastfeeding.

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Health
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hal-04553013 , version 1 (19-04-2024)

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Maria-Sole Chimenti, Rieke Alten, Maria-Antonieta d'Agostino, Elisa Gremese, Uta Kiltz, et al.. Sex-associated and gender-associated differences in the diagnosis and management of axial spondyloarthritis: addressing the unmet needs of female patients. RMD Open, 2021, 7 (3), pp.e001681. ⟨10.1136/rmdopen-2021-001681⟩. ⟨hal-04553013⟩
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