Sex-related differences in psoriatic arthritis (PsA) treatment outcomes

Sex-related differences are evident across multiple domains of psoriatic arthritis (PsA), including clinical presentation and treatment response. Across biologic and targeted therapies, female patients with PsA consistently demonstrate lower response and more frequent treatment discontinuation compared with males. However, mechanisms underlying sex-based differences in treatment response remain unclear. This gap is further limited by the underreporting of sex-disaggregated outcomes in clinical trials and observational studies. This review synthesizes current evidence on sex differences in treatment efficacy and drug persistence in PsA, with attention to variation across therapeutic drug classes. Potential mechanisms contributing to differential treatment response are explored, including differences in disease characteristics, comorbidities, pain perception, adiposity, pharmacokinetics, immune and inflammatory factors, and gender-related sociocultural factors. Understanding these disparities is essential to inform personalized treatment strategies and guide future sex-informed research in PsA.