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Sexual dimorphism in the prevalence, manifestation and outcomes of axial spondyloarthritis

Nature Reviews Rheumatology volume 18, pages 657–669 (2022)Cite this article

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Abstract

Axial spondyloarthritis (axSpA) is a chronic inflammatory disease that predominantly affects the axial skeleton, although it can affect peripheral joints, and extra-musculoskeletal manifestations also occur. Historically, axSpA was thought to be a disease predominantly seen in men, although with the advent of magnetic resonance imaging techniques and advances in research, this dogma has been challenged and refuted. Sex and gender are different concepts, and both can have a role in disease. In axSpA, consideration of the influence of sex and gender on the disease phenotype is necessary to predict outcomes and to enable the development of therapeutic approaches that are best suited to individual patients.

Key points

  • Sex and gender have important roles in disease, with differential contributions to axial spondyloarthritis (axSpA) phenotype, response to therapy and outcomes.

  • AxSpA has equal prevalence in women and men, contrary to evidence that initially (and falsely) indicated that it is a disease that predominantly affects men.

  • Women and men with axSpA have different phenotypes, which is important to keep in mind when assessing for this diagnosis in the clinical setting.

  • Anatomical, physiological and hormonal differences might account for axSpA phenotypic heterogeneity.

  • More research is needed to better understand the contributions of sex and gender to disease in axSpA.

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Fig. 1: Anatomical differences in pelvic anatomy in men and women with axial spondyloarthritis.

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Acknowledgements

This work was supported by a charitable contribution to the UMass Memorial Foundation from Timothy S. and Elaine L. Peterson (S.H.L.), by the SAA/Jane Bruckel Early Career Investigator in AxSpA Award (S.H.L.), and by the National Center for Advancing Translational Sciences, NIH, through UCSF-CTSI Grant Number TL1 TR001871 (R.S.). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.

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Authors and Affiliations

  1. Division of Rheumatology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA

    Rachael Stovall & Lianne S. Gensler

  2. Rheumatology Department, Radboud University Medical Centre, Nijmegen, Netherlands

    Irene E. van der Horst-Bruinsma

  3. Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, USA

    Shao-Hsien Liu

  4. Department of Rheumatology, Amsterdam UMC, VU University Medical Center, Amsterdam, Netherlands

    Tamara Rusman

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I.E.v.d.H.-B. has received honoraria, consultancy fees and/or research grants from AbbVie, Eli Lilly, BMS, MSD, Novartis, Pfizer and UCB Pharma. L.S.G. has received consultancy fees from AbbVie, Eli Lilly, Gilead, GSK, Janssen, Novartis, Pfizer and UCB, and research grants from Pfizer. T.R. has received research funding from Pfizer. The remaining authors declare no competing interests.

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Stovall, R., van der Horst-Bruinsma, I.E., Liu, SH. et al. Sexual dimorphism in the prevalence, manifestation and outcomes of axial spondyloarthritis. Nat Rev Rheumatol 18, 657–669 (2022). https://doi.org/10.1038/s41584-022-00833-0

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