Gender-specific differences in patients with psoriatic arthritis receiving ustekinumab or tumour necrosis factor inhibitor: real-world data

Rheumatology (Oxford). 2023 Feb 22;kead089. doi: 10.1093/rheumatology/kead089. Online ahead of print.


Objective: Investigate effects of gender on disease characteristics and treatment impact in patients with psoriatic arthritis (PsA).

Methods: PsABio is a non-interventional European study in patients with PsA starting a biological disease-modifying anti-rheumatic drug (bDMARD; ustekinumab or tumour necrosis factor inhibitor [TNFi]). This post-hoc analysis compared persistence, disease activity, patient-reported outcomes and safety between male and female patients at baseline and 6 and 12 months of treatment.

Results: At baseline, disease duration was 6.7 and 6.9 years for 512 females and 417 males respectively. Mean (95% CI) scores for females versus males were: clinical Disease Activity Index for Psoriatic Arthritis (cDAPSA), 32.3 (30.3;34.2) versus 26.8 (24.8;28.9); Health Assessment Questionnaire-Disability Index (HAQ-DI), 1.3 (1.2;1.4) versus 0.93 (0.86;0.99); total Psoriatic Arthritis Impact of Disease-12 (PsAID-12) score, 6.0 (5.8;6.2) versus 5.1 (4.9;5.3), respectively. Improvements in scores were smaller in female than male patients. At 12 months, 175/303 (57.8%) female and 212/264 (80.3%) male patients achieved cDAPSA low disease activity, 96/285 (33.7%) and 137/247 (55.5%), achieved minimal disease activity (MDA), respectively. HAQ-DI scores were 0.85 (0.77;0.92) versus 0.50 (0.43;0.56), PsAID-12 scores 3.5 (3.3;3.8) versus 2.4 (2.2;2.6), respectively. Treatment persistence was lower in females than males (p = <0.001). Lack of effectiveness was the predominant reason to stop, irrespective of gender and bDMARD.

Conclusions: Before starting bDMARDs, females had more severe disease than males and a lower percentage reached favourable disease states, with lower persistence of treatment after 12 months. A better understanding of the mechanisms underlying these differences may improve therapeutic management in females with PsA.

Trial registration:,, NCT02627768.

Keywords: Psoriatic arthritis; bDMARD; disease activity; disease impact; gender; persistence; real-world.

Associated data