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Gender characterization in a large series of Brazilian patients with spondyloarthritis

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Abstract

An increasing number of women have been diagnosed with spondyloarthritis (SpA) in recent decades. While a few studies have analyzed gender as a prognostic factor of the disease, no studies have addressed this matter with a large number of patients in South America, which is a peculiar region due to its genetic heterogeneity. The aim of the present study was to analyze the influence of gender on disease patterns in a large cohort of Brazilian patients with SpA. A prospective study was carried out involving 1,505 patients [1,090 males (72.4%) and 415 females (27.6%)] classified as SpA according to the European Spondyloarthropaties Study Group criteria who attended at 29 reference centers for rheumatology in Brazil. Clinical and demographic variables were recorded and the following disease indices were administered: Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Radiologic Index (BASRI), Maastricht Ankylosing Spondylitis Enthesitis Score (MASES), and Ankylosing Spondylitis Quality of Life (ASQoL). Ankylosing spondylitis (AS) was the most frequent disease in the group (65.4%), followed by psoriatic arthritis (18.4%), undifferentiated SpA (6.7%), reactive arthritis (3.3%), arthritis associated to inflammatory bowel disease (3.2%), and juvenile SpA (2.9%). The male-to-female ratio was 2.6:1 for the whole group and 3.6:1 for AS. The females were older (p < 0.001) and reported shorter disease duration (p = 0.002) than the male patients. The female gender was positively associated to peripheral SpA (p < 0.001), upper limb arthritis (p < 0.001), dactylitis (p = 0.011), psoriasis (p < 0.001), nail involvement (p < 0.001), and family history of SpA (p = 0.045) and negatively associated to pure axial involvement (p < 0.001), lumbar inflammatory pain (p = 0.042), radiographic sacroiliitis (p < 0.001), and positive HLA-B27 (p = 0.001). The number of painful (p < 0.001) and swollen (p = 0.006) joints was significantly higher in the female gender, who also achieved higher BASDAI (p < 0.001), BASFI (p = 0.073, trend), MASES (p = 0.019), ASQoL (p = 0.014), and patient’s global assessment (p = 0.003) scores, whereas the use of nonsteroidal anti-inflammatory drugs (p < 0.001) and biological agents (p = 0.003) was less frequent in the female gender. Moreover, BASRI values were significantly lower in females (p < 0.001). The female gender comprised one third of SpA patients in this large cohort and exhibited more significant peripheral involvement and less functional disability, despite higher values in disease indices.

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Acknowledgments

The electronic version of the Brazilian Registry of Spondyloarthritis is maintained by an unrestricted grant of Wyeth/Pfizer Brazil that did not influence in the statistical analysis and in the writing of the manuscripts. Dr. Sampaio-Barros is a recipient of a research grant from Federico Foundation, Switzerland.

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Authors and Affiliations

  1. Hospital de Base do Distrito Federal, Unidade de Reumatologia, 11º andar. SMHS-Área Especial-Q. 101, Brasília, DF, CEP 70330-000, Brazil

    Hellen M. S. de Carvalho

  2. Insper Institute of Education and Research, São Paulo, SP, Brazil

    Adriana B. Bortoluzzo

  3. Division of Rheumatology, Universidade de São Paulo, São Paulo, SP, Brazil

    Célio R. Gonçalves & Percival D. Sampaio-Barros

  4. Universidade de Brasília, Brasília, DF, Brazil

    José Antonio Braga da Silva

  5. Hospital Geral de Goiânia, Goiânia, GO, Brazil

    Antonio Carlos Ximenes

  6. Universidade de Campinas, Campinas, SP, Brazil

    Manoel B. Bértolo

  7. Universidade Federal do Amazonas, Manaus, AM, Brazil

    Sandra L. E. Ribeiro

  8. Pontifícia Universidade Católica, Porto Alegre, RS, Brazil

    Mauro Keiserman

  9. Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil

    Rita Menin

  10. Hospital Evangélico de Curitiba, Curitiba, PR, Brazil

    Thelma L. Skare

  11. Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil

    Sueli Carneiro

  12. Universidade Estadual do Rio de Janeiro, Rio de Janeiro, RJ, Brazil

    Sueli Carneiro & Elisa N. Albuquerque

  13. Universidade Federal do Paraná, Curitiba, PR, Brazil

    Valderílio F. Azevedo

  14. Hospital Geral de Fortaleza, Fortaleza, CE, Brazil

    Walber P. Vieira

  15. Santa Casa do Rio de Janeiro, Rio de Janeiro, RJ, Brazil

    Washington A. Bianchi

  16. Pontifícia Universidade Católica, Campinas, SP, Brazil

    Rubens Bonfiglioli

  17. Santa Casa de São Paulo, São Paulo, SP, Brazil

    Cristiano Campanholo

  18. Universidade Federal do Mato Grosso do Sul, Campo Grande, MS, Brazil

    Izaias P. Costa

  19. Universidade Federal de Pernambuco, Recife, PE, Brazil

    Angela P. Duarte

  20. Universidade Federal do Espírito Santo, Vitória, ES, Brazil

    Maria Bernadete O. Gavi

  21. Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil

    Charles L. Kohem

  22. Faculdade de Medicina Souza Marques, Rio de Janeiro, RJ, Brazil

    Nocy H. Leite

  23. Hospital do Servidor Público Estadual, São Paulo, SP, Brazil

    Sonia A. L. Lima

  24. Instituto de Ortopedia e Traumatologia, Universidade de São Paulo, São Paulo, SP, Brazil

    Eduardo S. Meirelles

  25. Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil

    Ivânio A. Pereira

  26. Universidade Federal de São Paulo, São Paulo, SP, Brazil

    Marcelo M. Pinheiro

  27. Santa Casa de Belo Horizonte, Belo Horizonte, MG, Brazil

    Elizandra Polito

  28. Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil

    Gustavo G. Resende

  29. Universidade Federal do Ceará, Fortaleza, CE, Brazil

    Francisco Airton C. Rocha

  30. Escola de Medicina e Saúde Pública, Salvador, BA, Brazil

    Mittermayer B. Santiago

  31. Universidade Federal do Pará, Belém, PA, Brazil

    Maria de Fátima L. C. Sauma

Authors
  1. Hellen M. S. de Carvalho
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  2. Adriana B. Bortoluzzo
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  3. Célio R. Gonçalves
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  4. José Antonio Braga da Silva
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  6. Manoel B. Bértolo
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  7. Sandra L. E. Ribeiro
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  8. Mauro Keiserman
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  9. Rita Menin
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  10. Thelma L. Skare
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  12. Valderílio F. Azevedo
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  14. Elisa N. Albuquerque
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  15. Washington A. Bianchi
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  16. Rubens Bonfiglioli
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  17. Cristiano Campanholo
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  18. Izaias P. Costa
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  19. Angela P. Duarte
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  20. Maria Bernadete O. Gavi
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  21. Charles L. Kohem
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  22. Nocy H. Leite
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  23. Sonia A. L. Lima
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  24. Eduardo S. Meirelles
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  25. Ivânio A. Pereira
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  26. Marcelo M. Pinheiro
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  27. Elizandra Polito
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  28. Gustavo G. Resende
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  29. Francisco Airton C. Rocha
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  30. Mittermayer B. Santiago
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  31. Maria de Fátima L. C. Sauma
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  32. Percival D. Sampaio-Barros
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from the Brazilian Registry on Spondyloarthritis

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Correspondence to Hellen M. S. de Carvalho.

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de Carvalho, H.M.S., Bortoluzzo, A.B., Gonçalves, C.R. et al. Gender characterization in a large series of Brazilian patients with spondyloarthritis. Clin Rheumatol 31, 687–695 (2012). https://doi.org/10.1007/s10067-011-1890-3

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