Spondyloarthropathy in the community: Differences in severity and disease expression in Alaskan Eskimo men and women

Objectives. To determine the relative severity and compare the clinical exp ression of spondyloarthropathy (SpA) in men and women. Methods, A clinical study was conducted in 43 women and 40 men who made up 80% of all individuals identified as having SpA in a community-wide epidemi ologic study of Alaskan Eskimos. The study included interviews, physical, l aboratory, radiographic and electrocardiographic examinations, record revie ws, and functional assessments. A measure of relative severity was develope d to evaluate disease impact in individual patients. The results in men and women were compared. Results. No significant differences between men and women were found in man y features, including the age of onset, frequency of inflammatory joint swe lling or inflammatory back pain, physical signs of sacroiliitis, presence o f skin changes, or positive family history of SpA. Women were less likely t o have sacroiliac joint fusion, advanced spinal changes, uveitis, severe ca rdiac conduction and valvular abnormalities, and elevated erythrocyte sedim entation rates. According to our relative severity measure, a smaller propo rtion of women had severe disease than men. Conclusion. Although as many women as men were affected by SpA in the commu nities studied, severe disease was seen more often in men and a number of d isease manifestations were more frequent or mon marked in men. These discre pancies in disease severity and expression may contribute to the underdiagn osis of SpA in women and the long standing impression that SpA is a disease predominantly of men.