Ana-Maria Orbai1, Jamie Perin1, Clémence Gorlier2, Laura C Coates3, Uta Kiltz4, Ying Ying Leung5, Penelope E Palominos6, Juan D Cañete7, Rossana Scrivo8, Andra Balanescu9, Emmanuelle Dernis10, Sandra Tälli11, Adeline Ruyssen-Witrand12, Martin Soubrier13, Sibel Aydin14, Lihi Eder15, Inna Gaydukova16, Ennio Lubrano17, Umut Kalyoncu18, Pascal Richette19, M Elaine Husni20, Josef S Smolen21, Maarten de Wit22, Laure Gossec2. 1. Johns Hopkins University, Baltimore, Maryland. 2. Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique and Pitié Salpêtrière Hospital, AP-HP, Paris, France. 3. University of Oxford, Oxford, UK. 4. Rheumazentrum Ruhrgebiet, Herne and Ruhr-University, Bochum, Germany. 5. Singapore General Hospital, Duke-NUS Medical School, Singapore. 6. Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil. 7. Hospital Clínic and IDIBAPS, Barcelona, Spain. 8. Sapienza Università di Roma, Rome, Italy. 9. Sf Maria Hospital, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania. 10. Le Mans Central Hospital, Le Mans, France. 11. East-Tallinn Central Hospital, Tallinn, Estonia. 12. Toulouse University Hospital, UMR 1027, INSERM, Université Paul Sabatier Toulouse III, Toulouse, France. 13. Gabriel Montpied Hospital, Clermont Ferrand, France. 14. University of Ottawa, the Ottawa Hospital Research Institute, Ottawa, Canada. 15. Women's College Hospital, University of Toronto, Toronto, Ontario, Canada. 16. North-western State Medical University, St. Petersburg, Russia. 17. University of Molise, Campobasso, Italy. 18. Hacettepe University, Ankara, Turkey. 19. Hopital Lariboisiere Centre Viggo Petersen, service de Rhumatologie and Universite Paris Diderot UFR de Medecine, INSERM UMR1132 Bioscar, Paris, France. 20. Cleveland Clinic, Cleveland, Ohio. 21. Medical University of Vienna, Vienna, Austria. 22. Amsterdam University Medical Centre, Amsterdam, Netherlands.
Abstract
OBJECTIVE: Sex differences may modify symptoms, disease expression, and treatment effects. The objective of this study was to evaluate the link between life impact and sex in psoriatic arthritis (PsA). METHODS: Remission and Flare in Psoriatic Arthritis (ReFlaP; ClinicalTrials.gov identifier: NCT03119805) was a study in 14 countries of consecutive adult patients with definite PsA. Participants underwent comprehensive PsA assessment using the following measures: Disease Activity in Psoriatic Arthritis (DAPSA), Minimal Disease Activity (MDA), and Psoriatic Arthritis Impact of Disease (PsAID). Disease activity was compared by sex using t-tests or Wilcoxon tests. The association of PsAID with sex was analyzed using hierarchical generalized linear models. RESULTS: Of 458 participants, 50.2% were male and the mean ± SD age was 53.1 ± 12.6 years. The mean ± SD PsA duration was 11 ± 8.2 years, and 51.5% of participants were being treated with biologic disease-modifying antirheumatic drugs. Women, compared to men, had worse mean ± SD Leeds Enthesitis Index scores (0.8 ± 1.7 versus 0.3 ± 0.9), pain on a numerical rating scale (NRS; range 0-10) (4.7 ± 2.7 versus 3.5 ± 2.7), HAQ DI scores (0.9 ± 0.7 versus 0.5 ± 0.6), fatigue on an NRS (5.2 ± 3 versus 3.3 ± 2.8), and PsAID scores (4.1 ± 2.4 versus 2.8 ± 2.3) (P < 0.001 for all). Women were also less frequently at treatment target compared to men according to DAPSA (cutoffs of ≤4 for remission and >4 and ≤14 for low disease activity; mean ± SD score 16.9 ± 14.9 in women versus 12.6 ± 16.6 in men) and MDA (25.7% versus 50.0%; P < 0.001 for all) scores. High life impact (PsAID score ≥4) was associated with female sex (odds ratio [OR] 2.3), enthesitis (OR 1.34), tender joints (OR 1.10)(P < 0.001 for all), and comorbidities (OR 1.22, P = 0.002). CONCLUSION: High life impact was independently associated with female sex, enthesitis, comorbidities, and tender joints. At treatment target, women had higher life impact compared to men. It is necessary for life impact to become a part of PsA treat-to-target strategies.
OBJECTIVE: Sex differences may modify symptoms, disease expression, and treatment effects. The objective of this study was to evaluate the link between life impact and sex in psoriatic arthritis (PsA). METHODS: Remission and Flare in Psoriatic Arthritis (ReFlaP; ClinicalTrials.gov identifier: NCT03119805) was a study in 14 countries of consecutive adult patients with definite PsA. Participants underwent comprehensive PsA assessment using the following measures: Disease Activity in Psoriatic Arthritis (DAPSA), Minimal Disease Activity (MDA), and Psoriatic Arthritis Impact of Disease (PsAID). Disease activity was compared by sex using t-tests or Wilcoxon tests. The association of PsAID with sex was analyzed using hierarchical generalized linear models. RESULTS: Of 458 participants, 50.2% were male and the mean ± SD age was 53.1 ± 12.6 years. The mean ± SDPsA duration was 11 ± 8.2 years, and 51.5% of participants were being treated with biologic disease-modifying antirheumatic drugs. Women, compared to men, had worse mean ± SD Leeds Enthesitis Index scores (0.8 ± 1.7 versus 0.3 ± 0.9), pain on a numerical rating scale (NRS; range 0-10) (4.7 ± 2.7 versus 3.5 ± 2.7), HAQ DI scores (0.9 ± 0.7 versus 0.5 ± 0.6), fatigue on an NRS (5.2 ± 3 versus 3.3 ± 2.8), and PsAID scores (4.1 ± 2.4 versus 2.8 ± 2.3) (P < 0.001 for all). Women were also less frequently at treatment target compared to men according to DAPSA (cutoffs of ≤4 for remission and >4 and ≤14 for low disease activity; mean ± SD score 16.9 ± 14.9 in women versus 12.6 ± 16.6 in men) and MDA (25.7% versus 50.0%; P < 0.001 for all) scores. High life impact (PsAID score ≥4) was associated with female sex (odds ratio [OR] 2.3), enthesitis (OR 1.34), tender joints (OR 1.10)(P < 0.001 for all), and comorbidities (OR 1.22, P = 0.002). CONCLUSION: High life impact was independently associated with female sex, enthesitis, comorbidities, and tender joints. At treatment target, women had higher life impact compared to men. It is necessary for life impact to become a part of PsA treat-to-target strategies.
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