Spondyloarthritis in Women

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Historically this disease, and especially ankylosing spondylitis (also known as axial spondyloarthritis (axSpA) with x-ray damage) was thought to affect men more commonly than women. However, over the last decade as we recognize the disease earlier and in patients without the classic damage seen on x-ray, we realize this disease is actually equigender. Despite this, women continue to have a significantly longer delay in diagnosis compared to men. This may relate to persistent under-recognition of the disease (in general and in women particularly), and that women tend to have less damage on x-rays compared to men as well as less measurable inflammation in the blood (by C reactive protein [CRP]). Notwithstanding these differences, female patients have higher reported disease activity, proportionally greater functional impairment (ability to do certain daily activities), and worse quality of life.

Do Female vs. Male Patients Present Differently?

Men tend to have more radiographic damage and a higher burden of inflammation.

Women with early axSpA have greater subjective disease activity.
Women tend to have more widespread pain (WSP): those with WSP also have a significantly longer delay to diagnosis.
Women with definite sacroiliitis may experience more fatigue, peripheral involvement, and relevant family history than men.
Women have more functional impairment, despite less damage.

When female patients eventually make it to the rheumatologist and are given a correct diagnosis, they have often previously been misdiagnosed. The most common incorrect diagnoses are fibromyalgia (though this can coexist with AxSpA), chronic back pain, and foot pain. Affected women tend to have more peripheral (of the arms and legs) joint involvement and a higher prevalence of inflammatory bowel disease compared to men. They often report more family history of spondyloarthritis, though this doesn’t necessarily mean the genetics are different in women. It could reflect a tendency towards women’s greater knowledge of her family history. Fewer women have significant damage on x-rays at diagnosis (AS); over time, fewer women develop bamboo spine (fusion or ankylosis of the spine).

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