Disease outcome in male vs female sufferers from spondyloarthritis

A questionnaire with 78 questions concerning the situation of ankylosing spondylitis (AS) sufferers in Germany was distributed to representative 3000 out of the more than 14000 patient members of the German AS patients society (Deutsche Vereinigung Morbus Bechterew). 1614 patients (54%) responded. The age distribution of these patients roughly agrees with that expected due to the distribution of the age at diagnosis and the age distribution of the German population. As in the DVMB membership, two-thirds were male and one-third female. It turned out that at least 28% of the patients responding to the survey are not suffering from idiopathic AS but from other spondyloarthritides. Thus the results are also suited to compare AS, spondyloarthritic psoriasis, and spondyloarthritis combined with Crohn's disease or ulcerative colitis. With regard to the radiological stage according to Ott and Schilling, about 12% of the male patients but only 2% of the female patients have reached the final stage IV 15 years after disease onset. 30 (40) years after disease onset, the percentages are 37 (42)% for male patients and 17 (21)% for female patients, respectively. This means that the ankylosation proceeds much faster and more complete in male than in female patients. It does not mean, however, that the average outcome is "milder" in females as is often postulated: Severe pain is significantly more frequent in women. Concerning drug consumption, female patients are also at a disadvantage. The distribution of general well-being, handicap, and accompanying symptoms does not differ significantly. Whereas among the spondyloarthritis patients diagnosed before 1965, only about 10% were female, already nearly 50% are female among the patients diagnosed after 1990. This means that the criteria not depending on radiological changes only, make it more and more possible to diagnose also those spondyloarthritides in female patients that have often been overlooked in the past. Reports written for patients on other results of the survey have been published in the newsletter "Bechterew-Brief" of the Deutsche Vereinigung Morbus Bechterew.