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2023-03-03T15:25:39.000Z

The effect of sex differences on quality of life in patients with psoriatic arthritis

Mar 3, 2023
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Learning objective: After reading this article, learners will be able to cite a new clinical development in psoriatic arthritis.

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Clinical manifestations of psoriatic arthritis (PsA) can vary, with symptoms including joint pain, spinal pain, skin and nail psoriasis, and fatigue, which can all lead to reduced quality of life (QoL).1 Symptoms can differ between patients, with sex potentially playing a role in the manifestation of disease. Previous data suggest that women are more likely to have polyarticular disease and suffer greater disability than men, who are more commonly affected by axial disease.1

Here, we discuss a cross-sectional survey assessing the differences in disease burden in male and female patients with PsA. You can find additional information of the effect of sex on adverse drug reactions in our previous article.

Study design1

Data used in this study was collected from a survey (the Adelphi PsA Disease Specific Programme) of patients and their dermatologists/rheumatologists across France, Germany, Italy, Spain, United Kingdom, and United States in 2018. Patients were recruited when visiting their rheumatologist or dermatologist for routine care or diagnosis. The data collection design is shown in Figure 1.

Figure 1. Study design* 

BSA, body surface area; CCI, Charlson Comorbidity Index; PROs, patient reported outcomes; PsA, psoriatic arthritis.
*Adapted from Gossec, et al.1

Results1

Physician-reported characteristics

Patient demographics and clinical characteristics were reported by the physician with a patient record form. The patient characteristics at the time of completing the record form are shown in Table 1. Both men and women had an average PsA duration of ~5 years, with a higher proportion of men being employed full-time compared to women. On average, women experienced fewer comorbidities than men.

Table 1. Patient characteristics*

Characteristic, %
(unless otherwise stated)

Women
(n = 1,047)

Men
(n = 1223)

p value

Mean age, years

48.3

48.8

0.42

Employment

 

< 0.01

              Working full-time

49.4

68.6

 

              Working part-time

8.6

5.1

 

              On long-term sick
              leave

1.4

3.5

 

              Homemaker

18.7

1.6

 

              Student

2.9

2.4

 

              Unemployed

5.8

4.7

 

              Retired

13.2

14.1

 

Mean CCI, score

1.10

1.15

< 0.01

Mean PsA duration, years

4.87

4.95

0.42

Receiving biologic treatment

53.7

55.1

0.38

Mean BSA involvement, score§

5.5

5.5

0.87

Mean 68-tender joint count, score

3.2

3.5

0.39

Mean 66-swollen joint count, score

4.1

4.5

0.03

BSA, body surface area; CCI, Charlson comorbidity index; PsA, psoriatic arthritis.
*Adapted from Gossec, et al.1
Women, n = 417; men, n = 510.
Women, n = 832; men, n = 972.
§
Women, n = 819; men, n = 973.
Women, n = 243; men, n = 276.
Women, n = 243; men, n = 256.

The differences in tender and swollen joint counts are shown in Figure 2. Men had a higher mean swollen joint count compared to women (4.5 vs 4.1; p = 0.03); however, there was no statistical difference in tender joint count between men and women.

Figure 2. Tender joint count and swollen joint count* 

*Adapted from Gossec, et al.1

Patient-reported outcomes

In this study, women reported a worse QoL (0.80 vs 0.82; p = 0.02) and greater disability (0.56 vs 0.41; p < 0.01) than men, as defined by the EuroQoL 5-dimension questionnaire (EQ-5D) utility scores and health assessment questionnaire disability index (HAQ-DI) scores. More women had a low or medium EQ-5D utility score compared with men (14.7% and 46.7% vs 11.6% and 42.5%, respectively). HAQ-DI scores and EQ-5D utility scores are shown in Figure 3 and Figure 4, respectively.

Figure 3. HAQ-DI scores* 

*Adapted from Gossec, et al.1

 

Figure 4. EQ-5D utility scores* 

*Adapted from Gossec, et al.1

There was a greater proportion of women (22.4%) compared with men (16%) reporting an unacceptable 12-item PsA impact of disease (PsAID12) score, demonstrating that women were impacted to a greater extent by their psoriasis then men. In addition, women reported greater activity impairment compared with men (27.9% vs 24.6%; p < 0.01) as measured by the Work Productivity and Activity Impairment Questionnaire. However, this did not translate to greater work time missed for patients who were employed, there were no differences found for work time missed between men and women. Further details on work productivity and daily activity in patients with PsA can be found in one of our previous articles.

Conclusion1 

Patients surveyed for this study had similar clinical characteristics, including disease activity and biologic use; however, women generally reported a worse QoL, with higher disability and work impairment compared to men, despite women experiencing fewer comorbidities. The authors noted several limitations of the study, including the self-reported nature of outcomes and the possible over-representation of patients who visit their physician more often.

Another study has suggested that women may experience higher disability, anxiety, and depression compared to men, with men achieving higher Psoriasis Area and Severity Index scores.2 Another factor contributing to observed sex-related QoL differences may be the use and efficacy of different treatments between men and women. An observational study found that among patients treated with a tumor necrosis factor inhibitor, women had worse patient-reported outcomes, with higher levels of anxiety and depression compared with men.3 The male patients on average were more likely to achieve a response after 6 months of treatment, with less side effects than women.3

Although it is not clear why these QoL differences occur, to the authors suggest that it may be due to the effect of sex hormones, differences in perceptions of pain, or differences in the way patients self-report disease impacts between sexes. Further research into these factors could provide insight into how treatment efficacy and QoL could be improved, with treatment regimens tailored to a patient’s sex.

  1. Gossec L, Walsh JA, Michaud K, et al. Women with psoriatic arthritis experience higher disease burden than men: findings from a real-world survey in the United States and Europe. J Rheumatol. 2023;50(2):192-196. DOI: 3899/jrheum.220154
  2. Nas K, Kiliç E, Tekeoğlu İ, et al. The effect of gender on disease activity and clinical characteristics in patients with axial psoriatic arthritis. Mod Rheumatol 2021;31(4):869-874. DOI: 1080/14397595.2020.1812870
  3. Højgaard P, Ballegaard C, Cordtz R, et al. Gender differences in biologic treatment outcomes-a study of 1750 patients with psoriatic arthritis using Danish Health Care Registers. Rheumatology (Oxford). 2018;57(9):1651-1660. DOI: 1093/rheumatology/key140

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