Objectives To investigate sex differences in patient-reported outcome measures (PROMs) among axSpA patients initiating their first TNFi and identify factors contributing to these disparities over the follow-up. Methods Data were included from 15 EuroSpA registries and consisted of axSpA patients initiating their first TNFi, with ≥2 measurements for each analysed PROM (BASDAI and BASFI, scale 0–100) taken at any time point. Linear mixed models were employed to analyse sex differences in PROMs over 24 months and to evaluate how baseline characteristics were related to the observed sex differences. Results We analysed 13 102 (38% women) in the BASDAI analyses and 10 623 (38% women) in the BASFI analyses. At follow-up, mean sex differences in BASDAI increased from 4.3 units at baseline (95% CI, 3.5–5.1)–8.0 (7.2–8.8) at 6 months, and in BASFI from 2.2 (1.4–3.1)–4.6 (3.6–5.5), with consistently worse scores in women. Baseline characteristics could not substantially account for the observed sex differences over time; however, the magnitude of the sex differences was reduced by HLA-B27 positivity, longer disease duration, and increased CRP levels, but increased by TNFi initiation in later years and peripheral arthritis. Conclusion In axSpA patients initiating their first TNFi, baseline sex differences in BASDAI and BASFI increased two-fold after 6 months of treatment and persisted thereafter, with worse scores in women. Several baseline characteristics moderated the sex differences, though none could fully account for them. These findings improve our understanding of sex differences and underscore their importance in axSpA.

中文翻译：

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接受肿瘤坏死因子抑制剂治疗的中轴型脊柱关节炎患者报告结果的性别差异及其与临床因素的关联


目的 调查首次接受 TNFi 治疗的 axSpA 患者中患者报告结果测量 (PROM) 的性别差异，并确定随访期间导致这些差异的因素。方法 数据来自 15 个 EuroSpA 登记处，由开始首次 TNFi 的 axSpA 患者组成，在任何时间点对每个分析的 PROM（BASDAI 和 BASFI，量表 0-100）进行≥2 次测量。采用线性混合模型来分析 24 个月内 PROM 的性别差异，并评估基线特征与观察到的性别差异之间的关系。结果 我们在 BASDAI 分析中分析了 13 102 名（38% 女性），在 BASFI 分析中分析了 10 623 名（38% 女性）。随访时，6 个月时，BASDAI 的平均性别差异从基线时的 4.3 个单位 (95% CI，3.5–5.1) 增加到 8.0 (7.2–8.8)，BASFI 的平均性别差异从 2.2 (1.4–3.1)–4.6 (3.6) –5.5），女性得分始终较差。基线特征不能充分解释随时间推移观察到的性别差异；然而，HLA-B27 阳性、病程延长和 CRP 水平升高降低了性别差异的程度，但晚年开始使用 TNFi 和外周关节炎则增加了性别差异。结论 在开始首次 TNFi 治疗的 axSpA 患者中，BASDAI 和 BASFI 的基线性别差异在治疗 6 个月后增加两倍，并在此后持续存在，女性得分较差。一些基线特征调节了性别差异，但没有一个能够完全解释它们。这些发现提高了我们对性别差异的理解，并强调了性别差异在 axSpA 中的重要性。