The disease burden of axial spondyloarthritis: through a gendered lens

UMMS Affiliation

Division of Epidemiology, Department of Population and Quantitative Health Sciences; Clinical and Population Health Research Program, Morningside Graduate School of Biomedical Sciences; Division of Rheumatology, Department of Medicine

Publication Date


Document Type



Epidemiology | Gender and Sexuality | Health Services Administration | Health Services Research | Musculoskeletal Diseases | Rheumatology


INTRODUCTION: Axial spondyloarthritis (axSpA) affects patients' health-related quality of life (HRQoL). Prior studies have documented gender differences in axSpA across the disease spectrum. Our study aims to assess gender differences on the effects of axSpA on patients' HRQoL.

METHOD: A secondary qualitative thematic analysis was conducted using data from in-depth interviews (n = 24) of patients with a rheumatologist-confirmed axSpA diagnosis. This analysis focused on gender and HRQoL themes including activity, occupation, sleep, healthcare system, mental health, medication usage, and relationships.

RESULTS: While men on average waited a year longer than women to tell healthcare providers about symptoms (2.5 years men versus 1.6 years women), the interval between first report of symptoms to diagnosis was ~ 2 years longer for women relative to men (7.5 women versus 9.3 years men). Women and men with axSpA shared more similarities than differences regarding the impact of disease on HRQoL including (1) physical health, (2) limited mobility, (3) occupation, (4) sleep, (5) healthcare system obstacles, (6) mental health, (7) medication usage, and (8) relationships. Some women reported being dismissed by doctors due to their gender, and some described the pain experienced during pregnancy and complications during birth.

CONCLUSIONS: axSpA adversely impacts HRQoL regardless of gender, but women seeking care for axSpA may experience greater challenges reaching a diagnosis. It is essential that providers recognize impaired HRQoL among men and women with axSpA. Future studies with larger sample sizes are needed to identify aspects of HRQoL to adequately address people with axSpA. Key Points * While men waited on average a year longer to tell their healthcare provider about their symptoms, the diagnostic delay is 2 years longer for women. * Women and men with axSpA have similar experiences regarding impacts on their health-related quality of life. * Some women describe difficulty during pregnancy and being dismissed by doctors due to their gender.


Axial spondyloarthritis, Disease burden, Gender, Health-related quality of life, Qualitative

DOI of Published Version



Khan S, Shridharmurthy D, Lapane KL, Dube C, Kay J, Yi E, Liu SH. The disease burden of axial spondyloarthritis: through a gendered lens. Clin Rheumatol. 2022 Apr;41(4):1115-1124. doi: 10.1007/s10067-021-06008-8. Epub 2022 Jan 6. PMID: 34988682. Link to article on publisher's site

Journal/Book/Conference Title

Clinical rheumatology

PubMed ID


Related Resources

Link to Article in PubMed