title: Different clinical expression of patients with ankylosing spondylitis according to gender in relation to time since onset of disease. Data from REGISPONSER.
abstract: OBJECTIVE
  To describe the differential characteristics by gender and time since disease onset in patients diagnosed with ankylosing spondylitis (AS) attending the Spanish rheumatology clinics, including those on the "Spanish Registry of spondyloarthritis" (REGISPONSER), as well as the diagnostic and therapeutic implications that this entails.
  
  
  METHODS
  This is a transversal and observational study of 1514 patients with AS selected from 2367 spondyloarthritis cases included in REGISPONSER. For each patient, the demographics, epidemiology, geriatric, clinical, laboratory, radiological, and therapeutic aspects were were evaluated and comprehensively recorded under the aegis of REGISPONSER, constituting the Minimum Basic identifying data for the disease. Physical function was assessed by Bath Ankylosing Spondylitis Functional Index (BASFI). Clinical activity was evaluated using erythrocyte sedimentation rate, C reactive protein and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Each patient underwent pelvic anteroposterior, anteroposterior and lateral lumbar spine as well as lateral cervical spine x rays; they were scored according to the Bath Ankylosing Spondylitis Spine Radiographic Index, which measures structural damage.
  
  
  RESULTS
  Of the 1514 patients screened, 1131 (74.7%) were men. We found significant differences in age at onset of symptoms as well as in the day of inclusion, between the two groups, being lower in men. We also obtained differences in the duration of the disease, which was lower in women. As for the existence of a history of AS among first-degree relatives, family forms were more common among women. The mean BASDAI score was also higher in women, regardless of time since onset of disease. In contrast, the improvement of pain with the use of NSAID's and radiological severity were higher in men, both reaching statistical significance.
  
  
  CONCLUSIONS
  Among the Spanish AS patients, there are some differences in the clinical manifestations, even when the time since onset of disease was controlled; we also found radiological differences by gender; men showing more structural damage, while women were more active. These data suggest that the phenotype of AS differs between genders. This can influence the subsequent diagnostic approach and therapeutic decisions.
authors.affiliation: Servicio de Reumatología, Hospital Universitario Reina Sofía/IMIBIC/Universidad de Córdoba, Córdoba, Spain. orcam84@hotmail.com
authors.forename: Rafaela
authors.initials: R
authors.lastname: Ortega Castro
authors.forename: Pilar
authors.initials: P
authors.lastname: Font Ugalde
authors.forename: M Carmen
authors.initials: MC
authors.lastname: Castro Villegas
authors.forename: Jerusalén
authors.initials: J
authors.lastname: Calvo Gutiérrez
authors.forename: Elisa
authors.initials: E
authors.lastname: Muñoz Gomariz
authors.forename: Pedro
authors.initials: P
authors.lastname: Zarco Montejo
authors.forename: Raquel
authors.initials: R
authors.lastname: Almodóvar
authors.forename: Juan
authors.initials: J
authors.lastname: Mulero Mendoza
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Torre-Alonso
authors.forename: Jordi
authors.initials: J
authors.lastname: Gratacós Masmitjá
authors.forename: Xavier
authors.initials: X
authors.lastname: Juanola Roura
authors.forename: Rafael
authors.initials: R
authors.lastname: Ariza Ariza
authors.forename: Pilar
authors.initials: P
authors.lastname: Fernández Dapica
authors.forename: Luis Francisco
authors.initials: LF
authors.lastname: Linares Ferrando
authors.forename: M Elia
authors.initials: ME
authors.lastname: Brito Brito
authors.forename: Eduardo
authors.initials: E
authors.lastname: Cuende Quintana
authors.forename: Carlos
authors.initials: C
authors.lastname: Vázquez Galeano
authors.forename: Manuel José
authors.initials: MJ
authors.lastname: Moreno Ramos
authors.forename: Eugenio
authors.initials: E
authors.lastname: Giménez Úbeda
authors.forename: José Carlos
authors.initials: JC
authors.lastname: Rodríguez Lozano
authors.forename: Manuel
authors.initials: M
authors.lastname: Fernández Prada
authors.forename: Rubén
authors.initials: R
authors.lastname: Queiro Silva
authors.forename: Estefanía
authors.initials: E
authors.lastname: Moreno Ruzafa
authors.forename: Enrique
authors.initials: E
authors.lastname: Júdez Navarro
authors.forename: Antonio Juan
authors.initials: AJ
authors.lastname: Más
authors.forename: Cristina
authors.initials: C
authors.lastname: Medrano Le Quement
authors.forename: Enrique
authors.initials: E
authors.lastname: Ornilla
authors.forename: Carlos
authors.initials: C
authors.lastname: Montilla Morales
authors.forename: Manuel
authors.initials: M
authors.lastname: Pujol Busquets
authors.forename: Teresa
authors.initials: T
authors.lastname: Clavaguera Poch
authors.forename: M Cruz
authors.initials: MC
authors.lastname: Fernández-Espartero
authors.forename: Loreto
authors.initials: L
authors.lastname: Carmona Ortell
authors.forename: Eduardo
authors.initials: E
authors.lastname: Collantes Estévez
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D013167:Spondylitis, Ankylosing / Q000175:diagnosis*; D013997:Time Factors
keywords: Ankylosing spondylitis; Bath Ankylosing Spondylitis Radiographic Index Spine; Clinical differences; Diferencias clínicas; Espondilitis anquilosante; REGISPONSER; Sex; Sexo