Spondyloarthritis in women: differences in disease onset, clinical presentation, and Bath Ankylosing Spondylitis Disease Activity and Functional indices (BASDAI and BASFI) between men and women with spondyloarthritides

Clin Rheumatol. 2011 Jan;30(1):121-7. doi: 10.1007/s10067-010-1581-5. Epub 2010 Sep 30.


The aim of this study is to assess the gender differences in spondyloarthritides (SpAs) in terms of disease onset, clinical presentation, and the Bath Ankylosing Spondylitis Disease Activity and Functional indices (BASDAI and BASFI). We analysed data from a predominantly female cohort. Five hundred and 16 patients (male:female = 172:344) with SpA who were assessed at our clinic were asked to complete a questionnaire addressing data related to their disease onset (first symptom at presentation, age at which the first symptom presented, age of diagnosis, and delay in diagnosis), clinical presentation (main problem the disease caused them, night pain/sleep disturbance, well-being over the past week, and well-being over the previous 6 months), disease activity indices (erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and BASDAI), and functional index (BASFI). Compared with men, women had greater age at presentation, longer disease duration, more delayed diagnoses and greater age at diagnosis. Back pain was the main presenting symptom equally distributed for both genders. Women had more neck, knee and hip pain as presenting symptoms, while men experienced more feet pain. Back pain is also the main problem that the disease is causing to both sexes. More women had lower back pain, fatigue, neck pain, and pain with pressure as the main problems caused by the disease, while men had more joint pains. Women had significantly greater night pain and sleep disturbance than men. Furthermore, they experienced a worse well-being over past week and over past 6 months in addition to a higher mean ESR (P < 0.005), CRP (NS), BASDAI (P < 0.005) and BASFI (P < 0.05) scores. With regard to the items of the BASDAI index, it displays that women experienced significantly more fatigue (BASDAI 1; P < 0.001), total back pain (BASDAI 2; P < 0.05), and longer duration of morning stiffness (BASDAI 6; P = 0.09). With regard to the items of the BASFI index, women showed greater difficulty in reaching high shelves (BASFI 3; P < 0.001), getting up from the floor when lying on their back (BASFI 5; P < 0.001), and looking over their shoulders (BASFI 8; P < 0.05). SpAs present and progress differently in men and women. Women have more neck, knee, and hip pain at presentation and their main problems arise from the neck, back (lower and upper), fatigue and enthesitis during the course of the disease, whilst in men, feet pain was reported more often as presenting symptom than in women, with joint pain being the main problem caused by the disease.

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Back Pain / etiology
  • Cohort Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neck Pain / etiology
  • Rheumatology / methods*
  • Severity of Illness Index
  • Sex Factors
  • Spondylitis, Ankylosing / diagnosis*
  • Spondylitis, Ankylosing / epidemiology*
  • Spondylitis, Ankylosing / physiopathology
  • Surveys and Questionnaires