ARD：女性银屑病关节炎患者关节功能受限更重，生活质量更差

来自加拿多伦多西部研究所和银屑病关节炎诊所的Lihi Eder等人进行了一项研究，该研究的目的是通过测量疾病活动度、关节损伤、生活质量和残疾情况等，来评估严重银屑病关节炎（PsA）患者性别相关的差异。研究结果在线发布在2013年4月的《风湿病学年鉴》(Ann Rheum Dis)上。研究表明，男性PSA患者更易发展为中轴关节受累和关节影像学损伤更重，然而，女性患者可能受到更多的功能限制，生活质量更差。

该横断面分析招募的研究对象源于就诊于大型PsA诊所的患者。研究者从诊所数据库检索出人口统计学、临床和影像学资料，及患者的生活质量和功能的评价。研究者依据修订的Steinbrocker积分（mSS）对放射线损害进行评估。研究者采用多因素回归模型，校准潜在混杂因素后，对性别和影像学关节损害、中轴关节受累、生活质量和功能状况等变量的关系进行分析。

研究结果如下：该研究共纳入345位男性患者和245位女性患者，中轴关节受累常见于男性（42.9% vs 31%，p=0.003）。校准潜在混杂因素后，多因素回归模型分析发现男性患者更可能发展为中轴关节受累（比值比[OR]:1.8，p=0.003）。同时，mSS数据揭示，男性患者的外周关节的影像学损害更可能严重。校准潜在混杂因素后，多因素回归模型分析发现男性mSS损伤可能比女性更高（OR 1.6：p=0.007）。基于数个患者的变量数据，女性比男性功能限制受累更重，生活质量更差。

研究发现，男性PSA患者更易发展为中轴关节受累、关节影像学累及更重；然而，女性患者可能受到更多的功能限制，生活质量更差。

Gender difference in disease expression, radiographic damage and disability among patients with psoriatic arthritis.
OBJECTIVE
The authors aimed to assess gender-related differences in severity of psoriatic arthritis (PsA) as reflected by measures of disease activity, joint damage, quality of life and disability.
METHODS
A cross-sectional analysis was performed among patients who have been followed in a large PsA clinic. Demographic, clinical and radiographic data as well as information about quality of life and function were retrieved from the clinic database. Radiographic damage was assessed according to modified Steinbrocker score (mSS). The association between gender and the following outcome variables, radiographic joint damage, axial involvement and measures of quality of life and function, was assessed by multivariate regression analysis after adjustment for potential confounders.
RESULTS
Three hundred and forty-five men and 245 women were included in the study. Axial involvement was more frequent in men (42.9% vs 31%, p=0.003). In multivariate analysis, adjusting for potential confounders, men were more likely to develop axial involvement (OR 1.8, p=0.003). Men were also more likely to develop more severe radiographic damage in the peripheral joints as evident by mSS. Men were more likely to be in a higher mSS damage category compared with women after adjusting for potential confounders in multivariate analysis (OR 1.6, p=0.007). Women suffered from more severe limitations in function and worse quality of life compared with men based on several patients' reported outcomes.
CONCLUSIONS
Men with PsA are more likely to develop axial involvement and radiographic joint damage, while women are more likely to report about limitation in function and impaired quality of life.