The Effects of Sex on Patient Reported Outcomes in Inflammatory Arthritis and Connective Tissue Diseases

Background: It was thought that women report higher pain than men. We studied if there was a sex difference for several patient reported outcomes (PROs) in rheumatic diseases. Materials and Methods: Health Assessment Questionnaire disability index (HAQ-DI) as well as 100 mm Visual Analogue Scale (VAS) for pain, fatigue, sleep disturbance, and patient global assessment were compared cross-sectionally between the sexes for ankylosingspondylitis (AS), psoriatic arthritis (PsA), rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and systemic sclerosis (SSc). Data were collected using standardized forms administered during routine care. Results: The sample included 136 patients (97 males) with AS, 200 (83 males) with PsA, 232 (40 males) with RA, 199 (12 males) with SLE, and 113 (17 males) with SSc. There were no significant differences in AS. There were sex differences in PsA for HAQ (0.85 females, 0.57 males; p < 0.003), pain (45.2 females, 36.8 males; p < 0.03), sleep (42.1 females, 31.6 males; p < 0.025), and not significantly for fatigue and global scores (fatigue: 44.4 females, 36.0 males; p < 0.07. global: 40.1 females, 33.1 males; p < 0.06). There were similar non-significant differences observed in RA and SLE; whereas, in SSc, men had a higher global assessment (52.9 males, 38.1 females; p < 0.03). Conclusions: A significant sex difference was observed in PsA with females reporting worse symptoms. In SSc, global assessments were worse in males possibly due to proportionately more diffuse cutaneous SSc. Sex differences for PROs are not consistent between rheumatic inflammatory diseases in prevalent patients.