October 15, 2025
According to a study published in Rheumatology, women with non-radiographic axial spondyloarthritis (nr-axSpA) are less likely than men to achieve low disease activity or inactive disease after one year of treatment.
Axial spondyloarthritis (axSpA) is an inflammatory condition that primarily affects the spine and sacroiliac joints, causing chronic back pain and sometimes affecting other parts of the body like the eyes or skin.
This research project analyzed data from the global PROOF study, which followed people newly diagnosed with axSpA for one year. The goal was to see whether men and women differ in how likely they are to reach low disease activity or inactive disease, particularly when using medications called TNF inhibitors (TNFi). The study focused on two forms: radiographic (r-axSpA), where joint damage is visible on X-rays, and non-radiographic (nr-axSpA), where damage isn’t yet visible.
Among 1,385 participants, about a third had nr-axSpA and two-thirds had r-axSpA. Men were more likely to have r-axSpA, higher inflammation levels, and more structural damage. Women tended to have higher symptom scores and more pain, despite often having less visible damage.
After one year, disease activity improved for both men and women. However, a clear pattern emerged in nr-axSpA: men were much more likely than women to reach low disease activity or inactive disease. For example, nearly half of men with nr-axSpA achieved low disease activity, compared to just over a quarter of women. Among those treated with TNFi, women with nr-axSpA were still less likely to reach these goals. In contrast, men and women with r-axSpA had similar outcomes.
The researchers suggest several reasons for this difference. In women with nr-axSpA, some pain may not come from inflammation but from mechanical or nerve-related causes, such as changes after childbirth or other joint conditions. This could make standard treatments like TNFi or NSAIDs less effective. Women also had slightly higher rates of fibromyalgia, a condition that amplifies pain perception. These factors may contribute to the lower likelihood of reaching low disease activity in women with nr-axSpA.
The study highlights the importance of careful diagnosis and treatment planning, especially for women with nr-axSpA whose pain does not respond as expected to anti-inflammatory treatments. Clinicians need to consider whether symptoms are truly due to axSpA or other factors.
In summary, while both men and women benefit from treatment, women with non-radiographic axSpA face a greater challenge in achieving low disease activity. For patients and doctors, this underscores the need for personalized assessment and management to ensure effective care.
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