When Damage and Disability Diverge: Unraveling Sex-Based Drivers of Axial Spondyloarthritis Burden

Claudia Marques¹, Gustavo Resende², Carla Saad³, Adriana Marinho⁴, Andressa Soares⁵, Beatriz Paiva⁶, Cleandro Pires⁷, Débora Rodrigues⁸, Glaucio Castro⁹, Guilherme Bulbol¹⁰, Jamile Carneiro¹¹, Manuella Ochtrop¹², José Mauro Fernandes¹³, Maria Bernadete Gavi¹⁴, Maria Eduarda Veiga³, Michel Yazbek¹⁵, Nara Cavalcanti¹⁶, Natalia Machado¹⁷, Olivio Malheiro¹⁸, Rafael Bassara Macedo¹⁹, Rejane Vieira²⁰, Ricardo Lage¹⁸, Rita Menin²¹, Rywka Golebiovski²², Sandra Ribeiro¹⁰, Thauana Oliveira²², Valquiria Diniz¹⁴, Percival Sampaio-Barros²³ and Marcelo Pinheiro²⁴, ¹Hospital das Clinicas - Universidade Federal de Pernambuco - UFPE, Recife, Pernambuco, Brazil, ²Hospital das Clinicas UFMG, Belo Horizonte, Brazil, ³Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil, Sao Paulo, Brazil, ⁴Fundação Hospital do Acre - AC, Rio Branco, Brazil, ⁵Hospital Universitário da Universidade Federal de Santa Catarina (UFSC) - SC, Florianópolis, Brazil, ⁶Faculdade de Medicina da Universidade Federal do Amazonas (UFAM) - AM, Manaus, Brazil, ⁷UNB, Brasilia, Distrito Federal, Brazil, ⁸Fundação Hospital do Acre - AC, Rio Branco, Acre, Brazil, ⁹Hospital Governador Celso Ramos (HCR) - SC, Florianópolis, Santa Catarina, Brazil, ¹⁰Faculdade de Medicina da Universidade Federal do Amazonas (UFAM) - AM, Manaus, Amazonas, Brazil, ¹¹Hospital de Base do Distrito Federal (HBDF) - DF, Brasilia, Distrito Federal, Brazil, ¹²Hospital Universitário Pedro Ernesto / UERJ - RJ, Rio de Janeiro, Rio de Janeiro, Brazil, ¹³Universidade Federal do Maranhão (UFMA) - MA, São Luiz, Maranhao, Brazil, ¹⁴Universidade Federal do Espírito Santo (UFES) - ES, Vitória, Espirito Santo, Brazil, ¹⁵Universidade Estadual de Campinas (UNICAMP) - SP, Campinhas, Sao Paulo, Brazil, ¹⁶Hospital das Clínicas da Universidade Federal de Pernambuco (UFPE) - PE, Recife, Pernambuco, Brazil, ¹⁷Universidade Fedral do Paraná (UFPR) - PR, Curitiba, Parana, Brazil, ¹⁸Hospital das Clínicas da Universidade Federal de Minas Gerais (UFMG) - MG, Belo Horizonte, Minas Gerais, Brazil, ¹⁹Rheumatology Division, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (USP), Sao Paulo, Sao Paulo, Brazil, ²⁰Universidade Estadual do Ceará (UECE) - CE, Fortaleza, Ceara, Brazil, ²¹Faculdade de Medicina de São José do Rio Preto (FAMERP) - SP, São José do Rio Preto, Sao Paulo, Brazil, ²²Escola Paulista de Medicina (EPM) - Universidade Federal de São Paulo (UNIFESP) - SP, São Paulo, Sao Paulo, Brazil, ²³Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil, São Paulo, Brazil, ²⁴UNIFESP/ EPM, São Paulo, São Paulo, Brazil

Meeting: ACR Convergence 2025

Keywords: Ankylosing spondylitis (AS), gender, spondyloarthritis

Session Information

Date: Monday, October 27, 2025

Title: (1405–1433) Spondyloarthritis Including Psoriatic Arthritis – Diagnosis, Manifestations, & Outcomes Poster II

Session Type: Poster Session B

Session Time: 10:30AM-12:30PM

Background/Purpose: Sex differences in axial spondyloarthritis (axSpA) are well recognized, but their clinical consequences remain understudied in real-world settings. This study aimed to assess sex-based differences in demographic, clinical, functional, and treatment-related characteristics among patients with axSpA, and to explore sex-specific predictors of disease burden

Methods: Cross-sectional analysis of patients with axSpA enrolled in the Brazilian Registry of Spondyloarthritis (RBE), a multicenter, observational cohort involving 46 referral centers across Brazil. Eligible participants were adults diagnosed with SpA and classified according to ASAS criteria. Disease activity and impact were assessed using validated indices: BASDAI, ASDAS-CRP, BASFI, BASMI, ASQoL, and mSASSS. Sex-stratified multivariable linear regression models were developed to identify independent predictors of disease activity, function, mobility, and quality of life. Model assumptions and multicollinearity were evaluated, and results were expressed as unstandardized beta coefficients with 95% confidence intervals.

Results: A total of 828 patients were included: 568 (68.6%) males and 260 (31.4%) females, with a similar median age between groups (p = 0.351). Although HLA-B27 positivity has been more frequent in males (71.0% vs. 29.0%; p = 0.009), the family history of SpA was more frequently reported by females (26.2% vs. 17.2%; p = 0.002), as well as anxiety (18.6% vs. 9.6%; p < 0.001; OR 2.14), depression (18.2% vs. 5.8%; p < 0.001; OR 3.58), and fibromyalgia (23.0% vs. 5.8%; p < 0.001; OR 4.80). Figure 1 illustrates significantly higher scores of BASDAI, ASDAS-CRP, BASFI, and ASQoL in women, while men had worse BASMI. Correlation matrices showed stronger associations between patient-reported outcomes in women and a stronger mSASSS–BASMI correlation in men. Multivariable models revealed distinct sex-specific patterns. In women, functional limitation (BASFI) and patient global assessment were consistent predictors across outcomes. In men, disease burden was associated with root joint pain, enthesitis, comorbidities (fibromyalgia, depression), and work status. Complementary logistic regression identified fibromyalgia, depression, family history, and higher BASDAI as independent correlates of female sex, while HLA-B27 positivity, hip limitation, and higher BASMI were associated with male sex.

Conclusion: These findings highlight contrasting profiles of axSpA by sex: a predominantly functional and subjective burden in women, and a more structural axial damage and inflammatory phenotype in men. Tailored assessment strategies may improve disease evaluation and management in both groups.

Figure 1. Sex-based comparison of disease activity, function, mobility, and quality of life in patients with axial spondyloarthritis

Disclosures: C. Marques: None; G. Resende: None; C. Saad: None; A. Marinho: None; A. Soares: None; B. Paiva: None; C. Pires: None; D. Rodrigues: None; G. Castro: None; G. Bulbol: None; J. Carneiro: None; M. Ochtrop: None; J. Fernandes: None; M. Gavi: None; M. Veiga: None; M. Yazbek: None; N. Cavalcanti: None; N. Machado: None; O. Malheiro: None; R. Bassara Macedo: None; R. Vieira: None; R. Lage: None; R. Menin: None; R. Golebiovski: None; S. Ribeiro: None; T. Oliveira: None; V. Diniz: None; P. Sampaio-Barros: None; M. Pinheiro: AbbVie/Abbott, 2, Johnson & Johnson, 2, UCB, 2.

To cite this abstract in AMA style:

Marques C, Resende G, Saad C, Marinho A, Soares A, Paiva B, Pires C, Rodrigues D, Castro G, Bulbol G, Carneiro J, Ochtrop M, Fernandes J, Gavi M, Veiga M, Yazbek M, Cavalcanti N, Machado N, Malheiro O, Bassara Macedo R, Vieira R, Lage R, Menin R, Golebiovski R, Ribeiro S, Oliveira T, Diniz V, Sampaio-Barros P, Pinheiro M. When Damage and Disability Diverge: Unraveling Sex-Based Drivers of Axial Spondyloarthritis Burden [abstract]. Arthritis Rheumatol. 2025; 77 (suppl 9). https://acrabstracts.org/abstract/when-damage-and-disability-diverge-unraveling-sex-based-drivers-of-axial-spondyloarthritis-burden/. Accessed .

« Back to ACR Convergence 2025

ACR Meeting Abstracts - https://acrabstracts.org/abstract/when-damage-and-disability-diverge-unraveling-sex-based-drivers-of-axial-spondyloarthritis-burden/