This study analyzed gender-related differences in a cohort of patients with psoriatic spondyloarthropathy (SpA) We performed a retrospective cross-sectional study of 100 patients (mean age 48 +/- 14 years; 63 men, 37 women), diagnosed as having psoriatic SpA on the basis of ESSG criteria. All patients were studied according to a standard protocol, and HLA-B27 and Cw status were analyzed in the study population and their frequencies compared to that of 177 healthy blood donors. The clinical features of PsSpA were compared between men and women by univariate analyses. Twenty-three patients showed isolated axial disease (M:F ratio 3.6:1), 36 had polyaxial disease (M:F ratio 1:1), and 41 showed oligoaxial pattern (M:F ratio 1.7:1). HLA-B27 was correlated with male sex (P=0.002) and isolated axial disease (P=0.016). Univariate analysis showed female sex to be correlated with lower complement levels (P < 0.05), erosive disease (P = 0.05), higher swelling joint count (P = 0.002), and higher scores on the Health Assessment Questionnaire-Specific for SpA (P < 0.05). The HLA-B27 antigen seems to be a defined genetic risk factor only in men with psoriatic SpA. The extent of the spondylitic process is quite similar between the two, although women show poorer functional performance and more aggressive peripheral disease.