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Women with nr-axSpA may experience a longer delay in diagnosis than men (9.8 years in women vs 8.4 years in men).1 The reason for this greater delay may partially result from differences in the clinical features of women compared to men. For example, women with nr-axSpA experience more widespread pain, subjective disease activity, fatigue, peripheral involvement, and functional impairment than men with nr-axSpA.2-4 Lower awareness of the prevalence of nr-axSpA in women may result in a lower index of suspicion on the part of the evaluating physician.5,6
The overlap of clinical features with fibromyalgia can also complicate the diagnosis and treatment of spondyloarthritis (including AS and nr-axSpA) in women, especially given the higher frequency of fibromyalgia among women.7
Reeti K. Joshi, MD
Reeti K. Joshi, MD
1. Feldtkeller E, Bruckel J, Khan MA. Scientific contributions of ankylosing spondylitis patient advocacy groups. Curr Opin Rheumatol. 2000;12(4):239-247.
2. Slobodin G, Reyhan I, Avshovich N, et al. Recently diagnosed axial spondyloarthritis: gender differences and factors related to delay in diagnosis. Clin Rheumatol. 2011;30(8):1075-1080.
3. Tournadre A, Pereira B, Lhoste A, et al. Differences between women and men with recent-onset axial spondyloarthritis: results from a prospective multicenter French cohort. Arthritis Care Res (Hoboken). 2013;65(9):1482-1489.
4. Lee W, Reveille JD, Davis JC Jr, et al. Are there gender differences in severity of ankylosing spondylitis? Results from the PSOAS cohort. Ann Rheum Dis. 2007;66(5):633-638.
5. Masson Behar V, Dougados M, Etcheto A, et al. Diagnostic delay in axial spondyloarthritis: a cross-sectional study of 432 patients. Joint Bone Spine. 2017;84(4):467-471.
6. Seo MR, Baek HL, Yoon HH, et al. Delayed diagnosis is linked to worse outcomes and unfavourable treatment responses in patients with axial spondyloarthritis. Clin Rheumatol. 2015;34(8):1397-1405.
7. Wendling D, Prati C. Spondyloarthritis and fibromyalgia: interfering association or differential diagnosis? Clin Rheumatol. 2016;35(9):2141-2143.
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Version: August 2019
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