title: Sex differences in pain scores and localization in inflammatory arthritis: a systematic review and metaanalysis.
abstract: OBJECTIVE
  To systematically identify and examine reports of sex-stratified pain measurements in patients with inflammatory arthritis.
  
  
  METHODS
  Data sources included PubMed (1950 to April 2010), Embase (1980 to April 2010), and manual searches of reference lists and conference abstracts. We included cohort studies and randomized trials comparing pain scores, treatment efficacy at reducing pain, or pain localization, between females and males with inflammatory arthritis [rheumatoid arthritis (RA), ankylosing spondylitis, psoriatic arthritis, and reactive arthritis].
  
  
  RESULTS
  Twenty-six cohorts and 1 randomized trial reported sex-stratified pain scores, and all but 1 cohort identified worse pain scores at enrollment in females. In a metaanalysis of mean visual analog scale (VAS) scores (0 to 10) in 16 RA cohort studies (reporting on 21,612 females and 6871 males), the standardized mean difference in VAS was 0.21 (95% CI 0.16, 0.26). Treatment with disease-modifying therapy results in improvement in mean scores for both sexes; however, female absolute scores remain higher. In 12 spondyloarthropathy cohorts reporting pain localization, females develop more peripheral arthritis during their disease course (68.9% vs 51.2%) but less inflammatory back pain (50.6% vs 66.4%).
  
  
  CONCLUSIONS
  We identified important sex differences in pain scores in inflammatory arthritis, with higher pain levels in females. In spondyloarthritis, females develop more peripheral arthritis and have less frequent spinal involvement compared to males. These differences may affect a clinician's perception of disease severity and activity, and thus influence management decisions.
authors.affiliation: Department of Medicine, University of Calgary, Calgary, Alberta, Canada. ccbarnab@ucalgary.ca
authors.forename: Cheryl
authors.initials: C
authors.lastname: Barnabe
authors.forename: Louis
authors.initials: L
authors.lastname: Bessette
authors.forename: Cathy
authors.initials: C
authors.lastname: Flanagan
authors.forename: Sharon
authors.initials: S
authors.lastname: Leclercq
authors.forename: Amanda
authors.initials: A
authors.lastname: Steiman
authors.forename: Fares
authors.initials: F
authors.lastname: Kalache
authors.forename: Tabitha
authors.initials: T
authors.lastname: Kung
authors.forename: Janet E
authors.initials: JE
authors.lastname: Pope
authors.forename: Boulos
authors.initials: B
authors.lastname: Haraoui
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Hochman
authors.forename: Dianne
authors.initials: D
authors.lastname: Mosher
authors.forename: Carter
authors.initials: C
authors.lastname: Thorne
authors.forename: Vivian
authors.initials: V
authors.lastname: Bykerk
mesh_terms: D018771:Arthralgia / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D001168:Arthritis / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007596:Joints / Q000473:pathology / Q000503:physiopathology; D008297:Male; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D012737:Sex Factors