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Are gender-specific...
Are gender-specific approaches needed in diagnosing early axial spondyloarthritis? Data from the SPondyloArthritis Caught Early cohort
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Ortolan, A. (author)
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van Lunteren, M. (author)
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Ramiro, S. (author)
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Ramonda, R. (author)
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Landewe, R. B. M. (author)
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Dagfinrud, H. (author)
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- Jacobsson, Lennart T. H., 1954 (author)
- Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för reumatologi och inflammationsforskning,Institute of Medicine, Department of Rheumatology and Inflammation Research
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van der Heijde, D. (author)
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van Gaalen, F. A. (author)
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Rbone Ld, Arthritis (author)
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Rheumatism, V. P. (author)
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Lin A, Arthritis (author)
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Rheumatism, V. P. (author)
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(creator_code:org_t)
- 2018-10-01
- 2018
- English.
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In: Arthritis Res Ther. - : Springer Science and Business Media LLC. - 1478-6354. ; 20
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https://gup.ub.gu.se...
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https://doi.org/10.1...
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Abstract
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- Background: Although gender differences have been observed in the severity of axial spondyloarthritis (axSpA), gender differences in disease presentation of early axSpA have not been thoroughly investigated. In particular, their impact on the diagnostic process is unknown. Methods: Baseline data from the SPondyloArthritis Caught Early cohort, which includes patients with chronic back pain (CBP; duration >= 3 months and <= 2 years, age of onset <45 years), were analysed. Patients underwent a full diagnostic work-up, including MRI and radiograph of the sacroiliac joints (MRI-SIJ and X-SIJ), to establish a diagnosis of axSpA. Characteristics of male and female patients with a certain diagnosis of axSpA (confidence level by the physician >= 7 on a 0-10 rating scale) were compared. Regression models were built for: the whole CBP cohort stratified by gender, to study which SpA features were associated most with diagnosis in each gender; and for axSpA patients, to test whether gender was associated with imaging positivity (MRI-SU+ and/or X-SU+). Results: Of the 719 CBP patients, 275 were male. With 146/275 males and 155/444 females diagnosed as axSpA, males were more likely to be diagnosed with axSpA (OR 2.1, 95% CI 1.5-2.9). Despite similar symptom duration, male axSpA patients were younger at diagnosis (27.4 +/- 7.5 vs 29.5 +/- 7.8 years; p = 0.02). Presence of SpA features was similar in male and female axSpA patients, except for HLA-B27 and imaging positivity that were more common in male axSpA patients (80% vs 60%; p < 0.01 and 78% vs 64%; p = 0.01). Nevertheless, these SpA features were still more prevalent in female axSpA patients than in no-axSpA patients, both females (HLA-B27(+) 23%, positive imaging 7%) and males (HLAB27(+) 34%, positive imaging 11%) (all p < 0.01). Moreover, in multivariable models with diagnosis of axSpA as outcome, HLA-B27 and imaging positivity were associated with the diagnosis in both sexes. In models with imaging positivity as outcome, male gender and HLA-B27 were both independently associated with MRI+ and/or X-SI+. Conclusions: While our data show clear gender differences in early axSpA, they highlight that HLA-B27 and imaging are still key elements for diagnosis in both genders. Our study does not suggest that separate diagnostic strategies for men and women are required.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Reumatologi och inflammation (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Rheumatology and Autoimmunity (hsv//eng)
Keyword
- Spondyloarthritis
- Gender
- Diagnosis
- Imaging
- sporadic ankylosing-spondylitis
- society classification criteria
- desir
- cohort
- positive patients
- disease onset
- back-pain
- women
- differ
- men
- age
- Rheumatology
Publication and Content Type
- ref (subject category)
- art (subject category)
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- By the author/editor
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Ortolan, A.
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van Lunteren, M.
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Ramiro, S.
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Ramonda, R.
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Landewe, R. B. M ...
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Dagfinrud, H.
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show more...
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Jacobsson, Lenna ...
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van der Heijde, ...
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van Gaalen, F. A ...
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Rbone Ld, Arthri ...
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Rheumatism, V. P ...
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Lin A, Arthritis
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show less...
- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Rheumatology and ...
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Arthritis Res Th ...
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Arthritis Resear ...
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University of Gothenburg