Achieving inactive disease state in men and women with axial spondyloarthritis: results from a multi-country prospective observational study.

Abstract

To assess the probability of achieving low disease activity (LDA) and inactive disease (ID) in men vs women with recently diagnosed axial spondyloarthritis (axSpA). This 1-year post-hoc analysis of the PROOF study assessed patients with recently diagnosed (≤12 months) axSpA. Patients were classified as having radiographic (r) or non-radiographic (nr) axSpA using central radiograph readings. Demographics, disease characteristics, and treatment were assessed at baseline and annually thereafter. Disease activity at 1 year was assessed by Axial Spondyloarthritis Disease Activity Score (ASDAS). 1385 patients with baseline and year 1 data were included. Patients were classified as having nr-axSpA (n = 477 [34%]; 47% men) or r-axSpA (n = 908 [66%]; 71% men). Men had higher TNF inhibitor (TNFi) use vs women with nr-axSpA (15% vs 9%; P = 0.0238) and r-axSpA (20% vs 13%; P = 0.0118). At 1 year, TNFi use increased, remaining significantly higher for men with r-axSpA (34.9% vs 28.1%; P = 0.0497) but not nr-axSpA. Significantly more men with nr-axSpA achieved ASDAS LDA (46.0% vs 27.1%; P = 0.0002) and ID (21.7% vs 9.6%; P = 0.0013); no significant difference was observed in r-axSpA. Female sex was associated with significantly lower odds of achieving LDA and ID in nr-axSpA only (odds ratio, men vs women, LDA: 2.23 [95% CI, 1.45, 3.42]; ID: 2.40 [1.39, 4.12]). Women with nr-axSpA, but not r-axSpA, were less likely to achieve LDA and ID after 1 year than men. These data stress the need to carefully evaluate the diagnosis and causes of pain in patients diagnosed with axSpA.