Although men and women are affected by psoriatic arthritis (PsA) in equal measure, studies have shown that sex may contribute to the presentation of the disease resulting in a different experience among men and women. Laure Gossec, MD, PhD, and colleagues conducted a cross-sectional study to examine this differentiation between the sexes in a real-world setting. The study, published in The Journal of Rheumatology, was based on surveys administered to rheumatologists and dermatologists and their patients throughout Europe and the United States.
Two Survey Phases
In the first portion of the survey, physicians provided information about the patients, including demographics, details of disease presentation, and the calculations resulting from 68-tender joint count (TJC68) and 66-swollen joint count (SJC-66). Also included was documentation of the body surface area affected as well as the Charlson Comorbidity Index score. The patients included in the physician-observation survey were then asked to complete a questionnaire that included the EuroQoL 5-Dimension questionnaire (EQ-5D), the Health Assessment Questionnaire Disability Index (HAQ-DI), the 12-item Psoriatic Arthritis Impact of Disease (PsAID12), and the Work Productivity and Impact questionnaire (WPAI). These data were gathered from a total of 2,270 patients recruited by 382 rheumatologists and 190 dermatologists. Of these patient participants, 1,047 were women and 1,223 were men. The demographics and clinical characteristics between men and women were comparable as well as their PsA manifestations.
Experience of Disease
Differences, however, were noted in the patient-reported outcomes gathered from the surveys (Table). Women participants expressed worse quality of life than men according to their responses to the EQ-5D utility score (0.80 vs 0.82, respectively; P=0.02). According to their responses on the HAQ-DI, women expressed a higher level of disability and compromised physical functioning than men (0.56 vs 0.41, respectively; P<0.01). The responses drawn from the PsAID12 score showed that women felt more greatly impacted by the disease than men (2.66 vs 2.27, respectively; P<0.01). In terms of fatigue and pain, women reported a more pronounced incidence than men (P<0.01). Overall diminished activity was reported more in women than men, according to the responses captured by the WPAI questionnaire (27.9% vs 24.6%, respectively; P<0.01). There were no differences noted for work time missed.
Impacting Treatment
When asked about the results observed in the study, Dr. Gossec said, “The findings suggest that men and women have different disease impact and severity profiles.” When asked about how physicians could apply this information to practices, she explained, “This would suggest that women should be carefully assessed for pain and quality of life and that the part of their symptoms unrelated to inflammation should be discussed, in a shared decision-making approach.” A range of factors may contribute to the varied experience of PsA among women and men patients. Dr. Gossec and colleagues wrote: “Biological factors, including the effect of sex hormones, gene expression, or differences in patient-reported perceptions of pain are thought to play a role in these sex differences.” When asked about future research on the topic of PsA experience based on sex, Dr. Gossec shared, “There are many unresolved questions regarding sex, gender, and PsA. These include the link between symptoms and hormones or auto-immunity, the part of symptoms explained by widespread pain syndrome, differential efficacy of drugs in women and men, and differentiation in this regard of selected modes of action.”
