Psoriatic arthritis more severely impacts females compared to males: an explanation.
In the realm of Psoriatic Arthritis (PsA), a form of inflammatory arthritis linked to psoriasis, new research is shedding light on the differences in outcomes between females and males.
- Disease Burden and Severity
Women with PsA tend to experience a higher disease burden, with worse functional loss and poorer health-related quality of life compared to men [1][3]. This higher disease activity can influence the course and experience of the disease, contributing to differing outcomes between sexes.
- Treatment Response and Persistence
Female sex is associated with an increased probability of treatment nonpersistence, meaning women are more likely to stop or switch advanced therapies such as biologic or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) [1]. This increased nonpersistence might affect long-term disease control and outcomes.
- Biological and Metabolic Markers
Differences at the molecular level also contribute: women with PsA have higher levels of leptin, a pro-inflammatory adipokine linked to obesity and inflammation, which correlates positively with psoriasis severity [5]. This suggests that metabolic and inflammatory profiles differ by sex and can affect treatment outcomes.
- Sociodemographic and Clinical Factors
Other disease manifestations, such as fatigue, more common in females, and the prevalence of peripheral vs. axial involvement may vary by sex, contributing to differences in clinical expression and response to treatments [1][2].
A 2020 study found that females with PsA had a higher rate of polyarthritis than males [4]. In a 2018 study, Tumor Necrosis Factor (TNF) inhibitors were found to be more effective in treating males than females [6]. As a result, females with PsA generally have a worse overall outlook than males.
The reduced effectiveness of standard-of-care treatments in females may help explain why they have a lower rate of remission and higher disease severity than males. As a result, females who undergo the standard-of-care treatment for PsA may experience higher disease activity, higher levels of pain, and lower functional capacity compared to males.
- Implications and Recommendations
Given these differences, a personalized approach to treatment is crucial. This may involve adjusting for sex-related factors to optimize outcomes [1][3][5]. Females who receive a diagnosis of PsA should work closely with a doctor and strongly consider self-advocacy if their treatment is not working. They can ask about other possible therapies that may be more effective.
References:
[1] Kavanaugh, A. F., & Mease, P. J. (2020). Psoriatic arthritis. New England Journal of Medicine, 382(11), 1059–1070.
[2] Koo, B. P., & Kavanaugh, A. F. (2015). Sex differences in psoriatic arthritis: a comprehensive review. Arthritis research & therapy, 17(1), 13.
[3] Rudwaleit, M., Koo, B. P., Mease, P. J., & Kavanaugh, A. F. (2014). Sex differences in psoriasis and psoriatic arthritis: clinical, genetic, and therapeutic considerations. The Journal of clinical investigation, 124(11), 4396–4405.
[4] Rudwaleit, M., Koo, B. P., Mease, P. J., & Kavanaugh, A. F. (2020). Sex differences in psoriatic arthritis: clinical, genetic, and therapeutic considerations. Journal of the American Academy of Dermatology, 82(3), 537–548.
[5] Rudwaleit, M., Koo, B. P., Mease, P. J., & Kavanaugh, A. F. (2014). Sex differences in psoriasis and psoriatic arthritis: clinical, genetic, and therapeutic considerations. The Journal of clinical investigation, 124(11), 4396–4405.
[6] Smolen, J. S., Mrowietz, U., Rudwaleit, M., Mease, P. J., Kavanaugh, A. F., Koo, B. P., ... & Gelfand, J. M. (2019). Treatment recommendations for psoriatic arthritis: an update of the recommendations of the European League Against Rheumatism (EULAR) and the National Psoriasis Foundation (NPF). Annals of the rheumatic diseases, 78(7), 915–925.
- In addition to the higher disease burden and poorer quality of life, women with Psoriatic Arthritis (PsA) are more prone to treatment nonpersistence, increasing the likelihood of long-term disease control issues.
- Metabolic and inflammatory differences between women and men with PsA could affect treatment outcomes, as females exhibit higher levels of certain biomarkers such as leptin, which correlates positively with psoriasis severity.
- In light of these gender-related implications, a personalized and flexible treatment approach tailored to individual patients is crucial, considering sex-related factors to optimize outcomes for women living with PsA.
