Ankylosing Spondylitis Response to TNF Inhibition Is Gender Specific: A 6-Year Cohort Study

Area of Science:

• Rheumatology
• Immunology
• Clinical Medicine

Background:

• Ankylosing spondylitis (AS) exhibits gender-specific differences in disease activity and severity.
• Tumor necrosis factor inhibitors (TNFi) are effective for AS, but gender-specific response variations may exist.

Purpose of the Study:

• To investigate potential gender-specific differences in response to TNFi therapy in ankylosing spondylitis patients.
• To analyze clinical and serological outcomes based on gender after initiating TNFi treatment.

Main Methods:

• Prospective follow-up of 147 AS patients initiating TNFi therapy between 2004 and 2011.
• Assessment of clinical and serological outcomes, including Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), and erythrocyte sedimentation rate (ESR).
• Collection of baseline radiographic data (mSASSS) and metrology indices (BASMI).

Main Results:

• Female AS patients had lower baseline Bath Ankylosing Spondylitis Metrology Index (BASMI) scores compared to males (p=0.01).
• At 3 months post-TNFi initiation, women exhibited significantly higher disease activity (BASDAI: p<0.01) and functional impairment (BASFI: p=0.03) than men.
• Female patients showed higher median ESR levels (p<0.01), which correlated with their disease activity scores (r=0.42, p=0.02).

Conclusions:

• Despite similar baseline disease activity, women with AS experienced significantly worse outcomes after TNFi therapy.
• Elevated ESR levels in women during TNFi therapy correlated with clinical disease activity.
• Further research is essential to understand gender-specific differences in AS pathogenesis and develop targeted therapies.