The effect of sex differences in patient perception of PsA

Studies have suggested that PsA treatment satisfaction can vary between patients and their physicians, which can negatively impact quality of life; however, this may differ between patients of different sexes. Although the incidence of PsA is similar between male and female patients, observational studies have shown that females report greater loss of function and are more likely to experience pain.^1,2

Here, we report results from a post-hoc analysis assessing the impact of sex differences in patients with PsA, presented by Eder at the European Alliance of Associations for Rheumatology (EULAR) 2023 Congress.¹

Survey design¹

Eligible patients were aged ≥18 years and had a self-reported diagnosis of PsA for at least one year prior to participation, reported using at least one biologic or synthetic disease-modifying anti-rheumatic drug, and visited a rheumatologist or dermatologist in the past 12 months. The survey design is shown in Figure 1.

*Data from Eder.¹

Results¹

Overall, 1,286 patients with PsA both met the inclusion criteria and responded to the survey. Patient characteristics were similar between the sexes; however, more female patients had taken steroids for their PsA and more were currently taking a disease-modifying anti-rheumatic drug. In addition, female patients were more likely to have a diagnosis of anxiety or depression and were more likely to be affected by osteoarthritis. Patient characteristics are shown in Table 1.

Table 1. Selected patient characteristics*

DMARD, disease-modifying anti-rheumatic drug; NSAID, non-steroidal anti-inflammatory drug; PsA, psoriatic arthritis. *Adapted from Eder.1
Characteristic, % (unless otherwise stated)	Female	Male
Weighted global total (n), %	52 (674)	48 (612)
Mean age, years	41.3	41.0
Mean time since PsA diagnosis, years	9.2	8.8
Country
Australia	2	4
Brazil	22	27
Canada	5	5
France	7	10
Spain	5	8
Taiwan	2	4
UK	8	9
US	47	33
PsA medications ever taken
Biologic	70	66
DMARD	72	67
NSAID	62	56
Steroid	57	43
Other prescription                medication	12	8
Current PsA medication
Biologic DMARD only	36	39
Oral DMARD only	32	33
Biologic and oral                DMARD	20	15
NSAIDs/steroids only	10	12

Regarding the effect of PsA on quality of life, female and male patients reported a largely similar impact, with the exception of female patients reporting higher impact on their level of physical activity and their mental wellbeing compared with males (p < 0.05), as shown in Figure 2.

*Adapted from Eder.¹

Female patients reported a greater social impact and were significantly more likely to go on permanent disability due to their PsA; however, men were more likely to experience decreased productivity at work, as shown in Figure 3.

*Data from Eder.¹ 

Female patients are more likely to discontinue treatment earlier. The most frequent reasons why patients switch or discontinue treatment are shown in Figure 4.¹

*Adapted from Eder.¹

Finally, patient satisfaction with communication between them and their rheumatologist was assessed. A similar proportion of both male and female patients were somewhat or very dissatisfied with the communication, with the majority being very or somewhat satisfied. The proportions are shown in Figure 5.

*Adapted from Eder.¹

Conclusion 

The speaker noted several limitations of this study, including the method of collection, as some patients may not have access to the internet; the majority of patients being from North America and Europe, as the results may not be representative of other regions; and the self-reported nature of the data.

However, this survey has demonstrated that female patients may experience a greater impact on their physical activity, mental wellbeing, and social life than male patients. Effects on work also differed between the sexes. Therefore, physicians should consider the impact of PsA on an individual basis and tailor support and treatment options accordingly.¹