Gender-attributable differences in outcome of ankylosing spondylitis: long-term results from the Outcome in Ankylosing Spondylitis International Study

Rheumatology (Oxford). 2016 Mar;55(3):419-28. doi: 10.1093/rheumatology/kev340. Epub 2015 Sep 18.


Objectives: To investigate gender-attributable differences regarding clinical outcome [disease activity, physical function and quality of life (QoL)] and radiographic damage in patients with AS over time.

Methods: Data from the Outcome in AS International Study were used. Disease activity was assessed by the BASDAI, ASDAS and CRP; physical function by BASFI; QoL by the Short Form-36, Ankylosing Spondylitis Quality of Life (ASQoL) score and European Quality Of Life scale; and radiographic damage by the modified Stoke AS Spine Score (mSASSS). Cross-sectional comparative analyses were done at baseline. Next, separate models were created to assess gender-attributable differences on each outcome measure over time using time-adjusted generalized estimating equations.

Results: A total of 216 patients [154 (72.3%) males, mean age 43.6 years (s.d. 12.7), symptom duration 20.5 years (s.d. 11.8), mean follow-up duration 8.3 years (s.d. 4.1)] were included. At baseline, male compared with female patients had lower self-reported disease activity (BASDAI 3.2 vs 3.9, P = 0.03) but more radiographic damage (mSASSS 13.8 vs 6.5, P = 0.02). No significant gender-attributable differences in other clinical parameters were found. In multivariable analysis, male gender was significantly associated with a better ASQoL (B = -1.18, 95% CI: -2.17, -0.20, P = 0.02), and in a separate model with a higher mSASSS over time (B = 8.24, 95% CI: 4.38, 12.09, P < 0.01).

Conclusion: In this prospective cohort study, no gender-attributable differences in disease activity or physical function over time were found. However, radiographic damage was more severe in males. Furthermore, males had a better QoL over time.

Keywords: ankylosing spondylitis; epidemiology; gender; longitudinal studies; sex.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Analysis of Variance
  • Anti-Inflammatory Agents / therapeutic use
  • Cross-Sectional Studies
  • Disability Evaluation*
  • Disease Progression
  • Exercise Therapy / methods
  • Female
  • Follow-Up Studies
  • Humans
  • Internationality
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Pain Measurement
  • Quality of Life*
  • Radiography
  • Risk Assessment
  • Severity of Illness Index
  • Sex Factors
  • Spondylitis, Ankylosing / diagnostic imaging*
  • Spondylitis, Ankylosing / drug therapy
  • Spondylitis, Ankylosing / physiopathology*
  • Time Factors
  • Treatment Outcome


  • Anti-Inflammatory Agents