Sex-specific differences in patients with psoriatic arthritis: a systematic review

Objective A systematic review of published literature was conducted to collate evidence on sex-specific differences in clinical characteristics, disease activity and patient-reported outcomes (PROs) in psoriatic arthritis (PsA), including response to treatment. Methods Searches of MEDLINE, Embase and the Cochrane Database of Systematic Reviews were performed in November 2020 for observational studies of adults with PsA reporting outcomes by sex (published 2015–), with hand searches of systematic literature review and (network) meta-analysis bibliographies, plus searches of ClinicalTrials.gov and congress abstracts from the European League Against Rheumatism, American College of Rheumatology and American Academy of Dermatology (2019–2020). Eligible studies pre-specified a comparison by sex and reported clinical characteristics and/or disease activity (N>100). Data extracted included patient characteristics, study design, baseline clinical characteristics, and disease activity results (including PROs). Results Database searching yielded 3,283 unique records; 31 publications (27 unique studies) were included. The review found generally higher rates of peripheral disease in women, including higher tender joint counts (TJCs). There was some evidence of more axial disease in men, plus greater skin disease burden. There were consistently no differences in Dermatology Life Quality Index scores, though across other PROs women had worse scores, including pain and fatigue. Women had poorer responses to treatment, indicated by outcome measures such as American College of Rheumatology responses and minimal disease activity. Conclusion This review indicates that important differences exist between the sexes in PsA. However, the limited evidence for this conclusion underlines the need for additional research in this area