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You are here: Home / Articles / Men, Women & Medical Differences in Axial Spondyloarthropathy

Men, Women & Medical Differences in Axial Spondyloarthropathy

October 24, 2019 • By Ruth Jessen Hickman, MD

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Nelosa/shutterstock.com

Historically, ankylosing spondylitis was considered mainly a male disease. But it has become evident this predominance is not as great as previously believed. Here we discuss recent developments in the area, including potential differences between the sexes in symptom and disease burden, immunological and genetic background, diagnostic delay, treatment response and ongoing research questions.

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Medical Differences Between Men & Women
Though historically underappreciated, a growing body of research has underscored important differences between men and women across many areas of medicine, including heart disease, human immunodeficiency virus and depression, influencing both disease presentation and treatment efficacy.1 In addition to obvious differences related to reproduction, men and women, on average, show important differences in immune function, brain organization, pain perception, metabolism, drug pharmacodynamics and lifestyle risk factors.2

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Generally speaking, these differences may be mediated by sex, gender or a combination of the two. Differences due to sex occur from direct biological effects of chromosomal composition, reproductive organ formation and their downstream of effects on sex hormone levels.1 As gene regulators, sex hormones may have a variety of complex effects, potentially serving to inactivate or activate the expression of genetic pathways important in disease pathophysiology.3 Differences due to gender occur due to a person’s self-representation and a complex milieu of social and cultural factors.1

Axial spondyloarthritis is one disease in which sex differences seem to play an important role. This includes both the earlier diagnostic category of ankylosing spondylitis (now considered roughly equivalent to radiographic axial spondyloarthritis in the official guidelines), as well as the category of non-radiographic axial spondyloarthritis, in which sacroiliitis cannot be demonstrated on standard radiography but can be visualized on magnetic resonance imaging (MRI).4

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Changing Categories of Ankylosing Spondylitis & Axial Spondyloarthritis
To understand how these  differences have played out over time, it is helpful to remember how diagnostic categories for axial spondyloarthritis have evolved. Vega Jovani, MD, PhD, a physician in the rheumatology department of University General Hospital of Alicante, Spain, explains, “In the modified New York criteria for diagnosing ankylosing spondylitis, it was necessary to have sacroiliitis on X-ray imaging.”5 Yet women, on the whole, display fewer radiographic changes compared with men.

photo of Dr. Jovani

Dr. Jovani.

In 2009, the Assessment of SpondyloArthritis International Society (ASAS) published classification criteria of axial spondyloarthritis, including both non-radiographic and radiographic subtypes.4 Dr. Jovani explains, “These specific ASAS criteria made the disease and its prevalence more visible in women.” Generally speaking, radiographic axial spondyloarthritis and non-radiographic axial spondyloarthritis can be thought of as different stages or manifestations of the broader axial spondyloarthritis category.6

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Filed Under: Conditions, Spondyloarthritis Tagged With: Ankylosing Spondylitis, axial spondyloarthritis (SpA), Gender, sexual dimorphismIssue: December 2019

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About Ruth Jessen Hickman, MD

Ruth Jessen Hickman, MD, was born and raised in eastern Kentucky, where she first cultivated her love of literature, writing and personal narratives. She attended Kenyon college, where she received a Bachelor of Arts in philosophy, summa cum laude. She worked with individuals with psychiatric conditions and later in a neuroscience lab at the University of Illinois, Chicago, before graduating from Indiana University Medical School in 2011. Instead of pursuing clinical medicine, Ruth opted to build on her strength of clearly explaining medical topics though a career as a freelance medical writer, writing both for lay people and for health professionals. She writes across the biomedical sciences, but holds strong interests in rheumatology, neurology, autoimmune diseases, genetics, and the intersection of broader social, cultural and emotional contexts with biomedical topics. Ruth now lives in Bloomington, Ind., with her husband, son and cat. She can be contacted via her website at ruthjessenhickman.com.

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