Background/Purpose: Psoriatic arthritis is a heterogenous disease that can effectively be treated with biologic therapy. The treatment outcome is affected by difference in disease expression and patients population. The aim of this study was to evaluate the patient reported outcome of the therapy and the disease activity in the perspective of gender differences.

Methods:  Data on patients with psoriatic arthritis were extracted from the Estonian Society for Rheumatology Biologic Therapy Register from 2008 to 2014. Demographic, clinical and disease activity measurements were evaluated at the initiation of the biologic therapy and at patients last recorded registry entry during the observational period. The association of gender and patient reported outcome measures and objective disease acitivity measures were assessed with Wilcoxon rank-sum test, linear regression was used to adapt for potential confounders.

Results: Among 107 patients (mean age 44.8 (standard deviation, ±12.4) years, mean stay in register 32.3 (±24.8) months, mean number of registry entries 5.4 (±2.8)) 53.3% were females. At the initiation of biologic therapy, female patients had more active disease by both subjective (visual analogue scale (VAS) value of pain, female vs male means 60.2 vs 47.7, p=0.0365; HAQ-DI 1.65 vs 0.70, p=0.0023) and objective disease activity measures (DAS28 5.2 vs 4.0, p=0.0071; BASDAI 6.8 vs 5.4, p=0.0423). Female patients had more active disease also at the last recorded visit (VAS pain 30.8 vs 17.6, p=0.0022; VAS global assessment 30.5 vs 16.2, p=0.0007; HAQ-DI 1.0573 vs 0.44, p=0.0085; DAS28 3.1 vs 1.8, p=0.0001; BASDAI 3.5 vs 2.2, p=0.0084). The differences persisted after adjustment for age, time in the register and change in the biologic therapy. During the treatment period all the objective and subjective disease activity measures improved without a gender difference with an exeption of HAQ-DI which showed bigger change in female patients (-1.00 vs -0.24, p= 0.0148).

Conclusion: Previous studies have shown that men have higher objective disease activity and are more likely to develop structural damage whereas women have higher activity in patient reported outcomes (1). In this study female patients were susceptible to more active disease regarding most aspects of psoriatic arthritis. However further studies are needed to evaluate the relationship to the disease expression or other manifestations of the disease and female gender. In this population there was no gender difference in treatment efficacy by objective measures.     1. Eder et al. Ann Rheum Dis 2013;72:578-582

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/patient-reported-disease-activity-and-efficacy-of-biologic-therapy-in-patients-with-psoriatic-arthritis-an-observational-study-of-107-patients-of-the-estonian-society-for-rheumatology-biologic-therap/