Different Clinical Expression of Patients With Ankylosing Spondylitis According to Gender in Relation to Time Since Onset of Disease. Data From REGISPONSER

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Jorge, Huesca, Spain" "etiqueta" => "l" "identificador" => "aff0060" ] 12 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital Santa Maria del Rosell, Murcia, Spain" "etiqueta" => "m" "identificador" => "aff0065" ] 13 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital Universitario Miguel Servet, Zaragoza, Spain" "etiqueta" => "n" "identificador" => "aff0070" ] 14 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital Doctor Negrín, Las Palmas de Gran Canaria, Islas Canarias, Spain" "etiqueta" => "o" "identificador" => "aff0075" ] 15 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital Universitario de Guadalajara, Guadalajara, Spain" "etiqueta" => "p" "identificador" => "aff0080" ] 16 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital Central de Asturias, Oviedo, Spain" "etiqueta" => "q" "identificador" => "aff0085" ] 17 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital San Rafael, Barcelona, Spain" "etiqueta" => "r" "identificador" => "aff0090" ] 18 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital Virgen del Perpetuo Socorro, Albacete, Spain" "etiqueta" => "s" "identificador" => "aff0095" ] 19 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital Fundación Son Llàtzer, Mallorca, Islas Baleares, Spain" "etiqueta" => "t" "identificador" => "aff0100" ] 20 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital Internacional Merimar, Alicante, Spain" "etiqueta" => "u" "identificador" => "aff0105" ] 21 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital Universitario Navarra, Pamplona, Navarra, Spain" "etiqueta" => "v" "identificador" => "aff0110" ] 22 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital Universitario Virgen de La Vega, Salamanca, Spain" "etiqueta" => "w" "identificador" => "aff0115" ] 23 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital Mutua de Terrassa, Terrassa, Barcelona, Spain" "etiqueta" => "x" "identificador" => "aff0120" ] 24 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital de Palamós, Girona, Spain" "etiqueta" => "y" "identificador" => "aff0125" ] 25 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital de Móstoles, Móstoles, Madrid, Spain" "etiqueta" => "z" "identificador" => "aff0130" ] 26 => array:3 [ "entidad" => "Unidad de Investigación de la Fundación Española de Reumatología, Madrid, Spain" "etiqueta" => "Aa" "identificador" => "aff0135" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Diferente expresión clínica de los pacientes con espondilitis anquilosante según el sexo en función del tiempo de evolución. Datos de REGISPONSER" ] ] "textoCompleto" => "IntroductionAnkylosing spondylitis (AS) is the prototype of a group of diseases known as spondyloarthritis and, as most of them, is a chronic inflammatory disease that primarily affects the spine and sacroiliac joints and can affect peripheral joints and/or enthesis<a class="elsevierStyleCrossRefs" href="#bib0005">1,2</a>; it a potentially serious disease that can cause significant functional disability and ultimately axial skeletal fusion (Ankylosis). Although considered a disease that mainly affects men, both in frequency and intensity, recent studies show that a significant proportion of AS patients are women (2–3 males per female)<a class="elsevierStyleCrossRefs" href="#bib0015">3–6</a>; in addition, disease in women is not as benign as previously thought, and in many cases constitutes a recognized cause of functional limitation.<a class="elsevierStyleCrossRef" href="#bib0035">7</a> The frequent delay in diagnosis of AS may be due in large part to the lack of recognition of the presence of this disease in women.<a class="elsevierStyleCrossRef" href="#bib0040">8</a>In April 2004 the Spanish Task Force for the Study of Spondyloarthritis of the Spanish Society of Rheumatology (GRESSER), launched a project to create a national registry of spondyloarthropathies called REGISPONSER, through a computerized central database (SQLserver) and shared via the internet <a href="http://biobadaser.ser.es/cgi-bin/regisponser/index.html">http://biobadaser.ser.es/cgi-bin/regisponser/index.html</a>. So far 31 rheumatology departments have participated in 31 hospitals in 19 provinces covering the spectrum of the Spanish population both from the demographic, social, labor and economic viewpoint. Today, it has more than 2000 patient's data regarding disease characteristics, clinical and radiological presentation and therapeutic response. This registry has been the basis for describing the clinical, demographic, analytical, radiological and metrological parameters of patients with spondyloarthritis in Spain.<a class="elsevierStyleCrossRefs" href="#bib0005">1,9</a>This article establishes the differential characteristics by gender and duration of disease of patients diagnosed with AS, as well as the diagnostic and therapeutic implications that this entails. To do this we compared the clinical, radiographic and functional outcomes and possible differences in severity considering gender and time since onset of disease.Patients and MethodsPatientsFor this study we selected 1514 of 2367 patients with AS composing the REGISPONSER database, of which 1131 (74.7%) were men and 383 (25.3%) women. The full details on the methodology and comprehensive compilation of the data included in REGISPONSER<a class="elsevierStyleCrossRefs" href="#bib0005">1,9</a> have been published previously.Compiled DataEach center had a trained rheumatologist who was responsible for patient assessment, data collection and compliance with the inclusion criteria. For our study we considered the following variables: age (years), gender, ethnicity (caucasian/other), first-degree family history (yes, no), smoking status (smoker or former smoker/non-smoker), marital status (married/single), type of work (sedentary, moderate, severe), SA disability and presence of human leukocyte antigen HLA-B27. Likewise, we collected the prior and current medications used by each patient (including the use of methotrexate, sulfasalazine, leflunomide, infliximab and etanercept) and improvement in pain with nonsteroidal antiinflammatory drugs (NSAIDs). Other data collected included the presence of symptoms such as peripheral arthritis, enthesitis, uveitis and coxitis, the presence of hip affection and systemic symptoms (cardiac, renal, neurological or pulmonary involvement, all categorized as yes or no). To measure disability, patients were asked to complete the “Bath Ankylosing Spondylitis Functional Index” (BASFI).<a class="elsevierStyleCrossRef" href="#bib0050">10</a> To measure disease activity, we considered the following quantitative variables: erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and the self-completion of the “Bath Ankylosing Spondylitis Disease Activity Index” (BASDAI).<a class="elsevierStyleCrossRef" href="#bib0055">11</a> Each patient underwent anteroposterior pelvic X-ray, anteroposterior and lateral lumbar spine and cervical spine X-ray, and were scored according to the “Bath Ankylosing Spondylitis Radiographic Index – Spinal” (BASRI-Spinal),<a class="elsevierStyleCrossRef" href="#bib0060">12</a> which measures structural damage.Statistical AnalysisWe performed a descriptive analysis of the clinical, epidemiological, radiographic and laboratory variables by gender and duration of disease. To do that, variables were stratified into 4 groups (0–9 years, 10–19, 20–39 and 40 years or more of disease progression). Subsequently, the first subgroup was analyzed by creating a new variable (0–4 years, 5–7 and 8–10 years). We calculated the mean and standard deviation for quantitative variables and absolute frequencies and percentages for qualitative variables. A bivariate test was performed using the Student's t test for independent data for quantitative variables and the chi-square test for qualitative variables. The values of “P” were adjusted by the Finner test. Subsequently, we performed a univariate factorial ANOVA with a Sidak adjustment for multiple comparisons to establish the differences in BASDAI, BASFI, BASRI, ESR and CRP by gender and duration of disease.All contrasts were bilateral and those considered significant had a P<0.05.ResultsDemographic and Clinical Characteristics<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the sociodemographic and clinical differences between men and women with AS of the 1514 patients selected. We found that there were significant differences between both groups in the mean age and the onset of symptoms at inclusion, being lower, in both cases, in men. There were also significant differences in the mean duration of disease, again lower in women. Regarding the existence of a history of AS among first-degree relatives, family forms were more frequent in the female group. For other sociodemographic characteristics there were no differences between the two groups, as occurred in the clinical expression, except for the presence of low back pain, which was more common among men.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Regarding treatment, there was no significant differences between genders in the drugs used previously. At the onset of the disease, the proportion of men using sulfasalazine was greater 87.9% than women (95% CI, 86.26–89.54) vs 83.3% (95% CI, 81.73–84.87), P=0.03. The improvement in pain of those patients taking NSAIDs was significantly more favorable in men.Disease ActivityTo assess disease activity we considered BASDAI, ESR and CRP. Compared to men, women had a higher average BASDAI score, regardless of the time of disease progression, with significant differences in all cases, except in those patients whose disease had a mean time interval of 20–39 years. This difference was accentuated in the group of 40 or more years of disease progression, where we observed that both the average score of the BASDAI as well as ESR and CRP levels were significantly higher in the women than in the men: BASDAI (cm) 5.25 (2.06) (95% CI, 4.18–6.32) vs 4.01 (2.39) (95% CI, 3.62–4.40), P=.033; ESR (mm/h) 36.56 (26.37) (95%, 29, 14–43.97) vs 17.85 (17.08) (95% CI, 15.01–20.70), P<.001, and CRP (mg/l) of 19.60 (30.44) (95%, 13.39–25.81) vs 8.42 (10.69) (95% CI, 6.03–10.81), P=.001.Both the average BASDAI score and CRP levels were significantly increased in the men related to the years of disease progression.Radiographic ResultsRadiological findings were more severe in men, with a mean score of 6.66 in BASRI – spinal (3.47) (95% CI, 6.45–6.87) vs 4.60 (2.67) (95% CI, 4.33–4.87) in women, P<.001. Adjusting for the duration of the disease, we found that the mean score of BASRI – spinal worsened significantly in both groups over the years, resulting in all cases in worse outcomes in men. In the subgroup of 0–10 years we saw that BASRI – spinal significantly increased over the years in men. When comparing both groups we confirmed that, from the early stages of the disease, the mean BASRI – spinal score was higher in men, except in the group of 5–7 years where there were no differences.Functional DisabilityGlobally, the BASFI increased significantly with time of disease progression although we cannot say that there were gender differences.DiscussionThe review of previously published studies showed that women have more peripheral arthritis and less axial radiographic changes. In our study, we found no differences in relation to the presence of peripheral involvement by gender, although it did occur relative to axial involvement, being higher in men with a better response to NSAID use. Although our study confirms that men have greater radiographic damage than women, there seems to be an apparent contradiction, since although the structural damage was significantly higher in men functional outcomes are the same in both groups. The study of Grand et al.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> showed no gender differences in mobility of the spine. Furthermore Dagfinrud et al.<a class="elsevierStyleCrossRef" href="#bib0065">13</a> found that changes in the mobility of the spine did not explain the observed differences in function; furthermore, the relationship between the radiographic structural damage and loss of function remains unknown. Even in the rheumatoid arthritis studies that have examined this question more fully, the nature of the relationship between the radiographic damage and functional loss is controversial, and may vary over the time course of the disease.<a class="elsevierStyleCrossRefs" href="#bib0070">14–16</a> This discrepancy between radiological damage and functional loss may be the result of women having more peripheral arthritis. The prevalence of HLA B27 among women with AS is equivalent to that of men.<a class="elsevierStyleCrossRef" href="#bib0020">4</a> From the data obtained in our study of the Spanish population we can conclude that there are differences in the clinical and radiographic findings of SA by gender. We observed that men show more structural damage than women with similar time since onset of the disease. Damage also increases with the progression of the disease regardless of gender. Although radiographic damage is lower in women, this group exhibits greater activity. These data suggest that the AS phenotype differs between genders and may influence the subsequent diagnostic and therapeutic choices. Regarding genetic data, there were no differences in the presence of positivity for HLA-B27, although women had more first-degree family history, which may suggest a different type of inheritance pattern in relation to genderEthical ResponsibilitiesProtection of People and AnimalsThe authors declare that procedures conformed to the ethical standards of the committee responsible for human experimentation and were in accordance with the World Medical Association Declaration of Helsinki.Data ConfidentialityThe authors declare that they have followed the protocols of their workplace regarding the publication of data from patients and all patients included in the study have received sufficient information and gave their written informed consent to participate in this study.Right to Privacy and Informed ConsentThe authors have obtained informed consent from patients and/or subjects referred to in the article. This document is in the possession of the corresponding author.Conflict of InterestThe authors have no disclosures to make." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:2 [ "identificador" => "xres222851" "titulo" => array:5 [ 0 => "Abstract" 1 => "Objective" 2 => "Patients and methods" 3 => "Results" 4 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec208307" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres222850" "titulo" => array:5 [ 0 => "Resumen" 1 => "Objetivo" 2 => "Pacientes y métodos" 3 => "Resultados" 4 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec208308" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Patients and Methods" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Patients" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Compiled Data" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Statistical Analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0030" "titulo" => "Results" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "Demographic and Clinical Characteristics" ] 1 => array:2 [ "identificador" => "sec0040" "titulo" => "Disease Activity" ] 2 => array:2 [ "identificador" => "sec0045" "titulo" => "Radiographic Results" ] 3 => array:2 [ "identificador" => "sec0050" "titulo" => "Functional Disability" ] ] ] 7 => array:2 [ "identificador" => "sec0055" "titulo" => "Discussion" ] 8 => array:3 [ "identificador" => "sec0060" "titulo" => "Ethical Responsibilities" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0065" "titulo" => "Protection of People and Animals" ] 1 => array:2 [ "identificador" => "sec0070" "titulo" => "Data Confidentiality" ] 2 => array:2 [ "identificador" => "sec0075" "titulo" => "Right to Privacy and Informed Consent" ] ] ] 9 => array:2 [ "identificador" => "sec0080" "titulo" => "Conflict of Interest" ] 10 => array:2 [ "identificador" => "xack50646" "titulo" => "Acknowledgments" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2011-12-13" "fechaAceptado" => "2012-09-19" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec208307" "palabras" => array:5 [ 0 => "Ankylosing spondylitis" 1 => "Bath Ankylosing Spondylitis Radiographic Index Spine" 2 => "Clinical differences" 3 => "Sex" 4 => "REGISPONSER" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec208308" "palabras" => array:5 [ 0 => "Espondilitis anquilosante" 1 => "Bath Ankylosing Spondylitis Radiographic Index Spine" 2 => "Diferencias clínicas" 3 => "Sexo" 4 => "REGISPONSER" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "ObjectiveTo describe the differential characteristics by gender and time since disease onset in patients diagnosed with ankylosing spondylitis (AS) attending the Spanish rheumatology clinics, including those on the “Spanish Registry of spondyloarthritis” (REGISPONSER), as well as the diagnostic and therapeutic implications that this entails. Patients and methodsThis is a transversal and observational study of 1514 patients with AS selected from 2367 spondyloarthritis cases included in REGISPONSER. For each patient, the demographics, epidemiology, geriatric, clinical, laboratory, radiological, and therapeutic aspects were evaluated and comprehensively recorded under the aegis of REGISPONSER, constituting the Minimum Basic identifying data for the disease. Physical function was assessed by Bath Ankylosing Spondylitis Functional Index (BASFI). Clinical activity was evaluated using erythrocyte sedimentation rate, C reactive protein and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Each patient underwent pelvic anteroposterior, anteroposterior and lateral lumbar spine as well as lateral cervical spine X-ray; they were scored according to the Bath Ankylosing Spondylitis Spine Radiographic Index, which measures structural damage. ResultsOf the 1514 patients screened, 1131 (74.7%) were men. We found significant differences in age at onset of symptoms as well as in the day of inclusion, between the two groups, being lower in men. We also obtained differences in the duration of the disease, which was lower in women. As for the existence of a history of AS among first-degree relatives, family forms were more common among women. The mean BASDAI score was also higher in women, regardless of time since onset of disease. In contrast, the improvement of pain with the use of NSAID's and radiological severity were higher in men, both reaching statistical significance. ConclusionsAmong the Spanish AS patients, there are some differences in the clinical manifestations, even when the time since onset of disease was controlled; we also found radiological differences by gender; men showing more structural damage, while women were more active. These data suggest that the phenotype of AS differs between genders. This can influence the subsequent diagnostic approach and therapeutic decisions." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "ObjetivoEstablecer las características diferenciales según el sexo y el tiempo de evolución de la enfermedad en aquellos pacientes diagnosticados de espondilitis anquilosante (EA) asistidos en consultas de reumatología de toda España, incluidos en el Registro Español de Espondiloartritis (REGISPONSER), así como la repercusión diagnóstica y terapéutica que ello conlleva. Pacientes y métodosEstudio transversal y observacional de 1.514 pacientes con EA seleccionados de entre 2.367 con espondiloartritis incluidos en REGISPONSER. En cada paciente se evaluaron y registraron de modo exhaustivo los datos demográficos, epidemiológicos, sociosanitarios, clínicos, analíticos, radiológicos y terapéuticos previstos en el protocolo de REGISPONSER que componen el Conjunto Mínimo Básico que identifica la enfermedad. La función física se evaluó mediante «Bath Ankylosing Spondylitis Functional Index». La actividad clínica mediante velocidad de sedimentación globular, proteína C reactiva y «Bath Ankylosing Spondylitis Disease Activity Index» (BASDAI). A cada paciente se le realizaron radiografías anteroposterior de pelvis, anteroposterior y lateral de columna lumbar y lateral de columna cervical, y se puntuaron según el índice «Bath Ankylosing Spondylitis Radiographic Index Spine» (BASRI-Spine), que mide el daño estructural. ResultadosDe los 1.514 pacientes seleccionados, 1.131 (74,7%) eran hombres. Encontramos que existen diferencias significativas en la edad tanto al inicio de los síntomas como en el día de la inclusión entre ambos grupos, siendo menor en los hombres. También obtuvimos diferencias en el tiempo de evolución de la enfermedad, que fue menor en el grupo de las mujeres. En cuanto a la existencia de antecedentes de EA entre los familiares de primer grado, las formas familiares fueron más frecuentes entre las mujeres, también resultó superior en éstas la puntuación media del BASDAI, con independencia del tiempo de evolución. Por el contrario, la mejoría del dolor con la toma de antiinflamatorios no esteroideos fue mayor en el caso de los hombres, así como la severidad radiológica, ambas de forma significativa. ConclusionesEntre los pacientes con EA españoles existen algunas diferencias en las manifestaciones clínicas y cuando se controló según el tiempo de evolución, también encontramos diferencias radiológicas según el sexo; los hombres muestran más daño estructural, mientras que las mujeres presentan mayor actividad. Estos datos sugieren que el fenotipo de EA difiere entre géneros, lo que puede influir en el manejo diagnóstico y posterior elección terapéutica." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Ortega Castro R, et al. Diferente expresión clínica de los pacientes con espondilitis anquilosante según el sexo en función del tiempo de evolución. Datos de REGISPONSER. Reumatol Clin. 2013;9:221–5" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "The data show the mean±SD for quantitative variables and absolute frequencies (%) for qualitative variables.AS: Ankylosing spondylitis; HLA: human leukocyte antigen; LL: lower limbs; UL: upper limbs; NS: not significant." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Men (n=1131) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Women (n=383) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">P<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sociodemographic</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age, years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">48.6 (13.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46.7 (11.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.017 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age at onset of symptoms, years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26.7 (10.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28.2 (10.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.017 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age at diagnosis, years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34.6 (12.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35.5 (11.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">n/a \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Time since onset, years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21.9 (13.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18.5 (11.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.007 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SA Family history, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.007 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Smoking, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.007 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Married, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">77.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">77.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">n/a \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Type of work, %</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sedentary \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">n/a \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Moderate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">n/a \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intense \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Occupational disability due to EA, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">66.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">54.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">n/a \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HLA B 27 positive, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">83.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">80.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">n/a \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Clinical</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lumbalgia, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">72.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">66.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.017 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">sacroiliac syndrome, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">n/a \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cervicalgia, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">n/a \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">peripheral arthritis, %</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">LL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17.2. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">n/a \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">UL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">n/a \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Enthesitis, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">n/a \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Uveitis, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">n/a \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Coxitis, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">n/a \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hip prosthesis, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">n/a \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cardiac involvement, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">n/a \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Renal involvement, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">n/a \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">neurological involvement, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">n/a \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pulmonary involvement, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.8% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">n/a \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab337031.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Student t test for independent data and chi-square, ‘P’ test corrected by the Finner test." ] ] ] "descripcion" => array:1 [ "en" => "Sociodemographic and Clinical Data of 1514 AS Patients by Gender." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:16 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Registro Nacional de Pacientes con Espondiloartropatías 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Original Article

Different Clinical Expression of Patients With Ankylosing Spondylitis According to Gender in Relation to Time Since Onset of Disease. Data From REGISPONSER

Diferente expresión clínica de los pacientes con espondilitis anquilosante según el sexo en función del tiempo de evolución. Datos de REGISPONSER

Rafaela Ortega Castroa,

Corresponding author

orcam84@hotmail.com
ecollantes@ser.es

Corresponding author.

, Pilar Font Ugaldea, M. Carmen Castro Villegasa, Jerusalén Calvo Gutiérreza, Elisa Muñoz Gomariza, Pedro Zarco Montejob, Raquel Almodóvarb, Juan Mulero Mendozac, Juan Carlos Torre-Alonsod, Jordi Gratacós Masmitjáe, Xavier Juanola Rouraf, Rafael Ariza Arizag, Pilar Fernández Dapicah, Luis Francisco Linares Ferrandoi, M. Elia Brito Britoj, Eduardo Cuende Quintanak, Carlos Vázquez Galeanol, Manuel José Moreno Ramosm, Eugenio Giménez Úbedan, José Carlos Rodríguez Lozanoo..., Manuel Fernández Pradap, Rubén Queiro Silvaq, Estefanía Moreno Ruzafar, Enrique Júdez Navarros, Antonio Juan Mást, Cristina Medrano Le Quementu, Enrique Ornillav, Carlos Montilla Moralesw, Manuel Pujol Busquetsx, Teresa Clavaguera Pochy, M. Cruz Fernández-Esparteroz, Loreto Carmona OrtellAa, Eduardo Collantes EstévezaVer más

a Servicio de Reumatología, Hospital Universitario Reina Sofía/IMIBIC/Universidad de Córdoba, Córdoba, Spain

b Servicio de Reumatología, Fundación Hospital de Alcorcón, Alcorcón, Madrid, Spain

c Servicio de Reumatología, Hospital Puerta de Hierro, Madrid, Spain

d Servicio de Reumatología, Hospital Monte Naranco, Oviedo, Spain

e Servicio de Reumatología, Hospital Parc Taulí, Barcelona, Spain

f Servicio de Reumatología, Hospital de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain

g Servicio de Reumatología, Hospital Virgen Macarena, Sevilla, Spain

h Servicio de Reumatología, Hospital Doce de Octubre, Madrid, Spain

i Servicio de Reumatología, Hospital Virgen de La Arrixaca, Murcia, Spain

j Servicio de Reumatología, Hospital Ramón y Cajal, Madrid, Spain

k Servicio de Reumatología, Hospital Universitario Príncipe de Asturias, Madrid, Spain

l Servicio de Reumatología, Hospital General S. Jorge, Huesca, Spain

m Servicio de Reumatología, Hospital Santa Maria del Rosell, Murcia, Spain

n Servicio de Reumatología, Hospital Universitario Miguel Servet, Zaragoza, Spain

o Servicio de Reumatología, Hospital Doctor Negrín, Las Palmas de Gran Canaria, Islas Canarias, Spain

p Servicio de Reumatología, Hospital Universitario de Guadalajara, Guadalajara, Spain

q Servicio de Reumatología, Hospital Central de Asturias, Oviedo, Spain

r Servicio de Reumatología, Hospital San Rafael, Barcelona, Spain

s Servicio de Reumatología, Hospital Virgen del Perpetuo Socorro, Albacete, Spain

t Servicio de Reumatología, Hospital Fundación Son Llàtzer, Mallorca, Islas Baleares, Spain

u Servicio de Reumatología, Hospital Internacional Merimar, Alicante, Spain

v Servicio de Reumatología, Hospital Universitario Navarra, Pamplona, Navarra, Spain

w Servicio de Reumatología, Hospital Universitario Virgen de La Vega, Salamanca, Spain

x Servicio de Reumatología, Hospital Mutua de Terrassa, Terrassa, Barcelona, Spain

y Servicio de Reumatología, Hospital de Palamós, Girona, Spain

z Servicio de Reumatología, Hospital de Móstoles, Móstoles, Madrid, Spain

Aa Unidad de Investigación de la Fundación Española de Reumatología, Madrid, Spain

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    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Diferente expresi&#243;n cl&#237;nica de los pacientes con espondilitis anquilosante seg&#250;n el sexo en funci&#243;n del tiempo de evoluci&#243;n&#46; Datos de REGISPONSER"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Ankylosing spondylitis &#40;AS&#41; is the prototype of a group of diseases known as spondyloarthritis and&#44; as most of them&#44; is a chronic inflammatory disease that primarily affects the spine and sacroiliac joints and can affect peripheral joints and&#47;or enthesis<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a>&#59; it a potentially serious disease that can cause significant functional disability and ultimately axial skeletal fusion &#40;Ankylosis&#41;&#46; Although considered a disease that mainly affects men&#44; both in frequency and intensity&#44; recent studies show that a significant proportion of AS patients are women &#40;2&#8211;3 males per female&#41;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;6</span></a>&#59; in addition&#44; disease in women is not as benign as previously thought&#44; and in many cases constitutes a recognized cause of functional limitation&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> The frequent delay in diagnosis of AS may be due in large part to the lack of recognition of the presence of this disease in women&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In April 2004 the Spanish Task Force for the Study of Spondyloarthritis of the Spanish Society of Rheumatology &#40;GRESSER&#41;&#44; launched a project to create a national registry of spondyloarthropathies called REGISPONSER&#44; through a computerized central database &#40;SQLserver&#41; and shared via the internet <a href="http://biobadaser.ser.es/cgi-bin/regisponser/index.html">http&#58;&#47;&#47;biobadaser&#46;ser&#46;es&#47;cgi-bin&#47;regisponser&#47;index&#46;html</a>&#46; So far 31 rheumatology departments have participated in 31 hospitals in 19 provinces covering the spectrum of the Spanish population both from the demographic&#44; social&#44; labor and economic viewpoint&#46; Today&#44; it has more than 2000 patient&#39;s data regarding disease characteristics&#44; clinical and radiological presentation and therapeutic response&#46; This registry has been the basis for describing the clinical&#44; demographic&#44; analytical&#44; radiological and metrological parameters of patients with spondyloarthritis in Spain&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;9</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">This article establishes the differential characteristics by gender and duration of disease of patients diagnosed with AS&#44; as well as the diagnostic and therapeutic implications that this entails&#46; To do this we compared the clinical&#44; radiographic and functional outcomes and possible differences in severity considering gender and time since onset of disease&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Patients</span><p id="par0020" class="elsevierStylePara elsevierViewall">For this study we selected 1514 of 2367 patients with AS composing the REGISPONSER database&#44; of which 1131 &#40;74&#46;7&#37;&#41; were men and 383 &#40;25&#46;3&#37;&#41; women&#46; The full details on the methodology and comprehensive compilation of the data included in REGISPONSER<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;9</span></a> have been published previously&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Compiled Data</span><p id="par0025" class="elsevierStylePara elsevierViewall">Each center had a trained rheumatologist who was responsible for patient assessment&#44; data collection and compliance with the inclusion criteria&#46; For our study we considered the following variables&#58; age &#40;years&#41;&#44; gender&#44; ethnicity &#40;caucasian&#47;other&#41;&#44; first-degree family history &#40;yes&#44; no&#41;&#44; smoking status &#40;smoker or former smoker&#47;non-smoker&#41;&#44; marital status &#40;married&#47;single&#41;&#44; type of work &#40;sedentary&#44; moderate&#44; severe&#41;&#44; SA disability and presence of human leukocyte antigen HLA-B27&#46; Likewise&#44; we collected the prior and current medications used by each patient &#40;including the use of methotrexate&#44; sulfasalazine&#44; leflunomide&#44; infliximab and etanercept&#41; and improvement in pain with nonsteroidal antiinflammatory drugs &#40;NSAIDs&#41;&#46; Other data collected included the presence of symptoms such as peripheral arthritis&#44; enthesitis&#44; uveitis and coxitis&#44; the presence of hip affection and systemic symptoms &#40;cardiac&#44; renal&#44; neurological or pulmonary involvement&#44; all categorized as yes or no&#41;&#46; To measure disability&#44; patients were asked to complete the &#8220;Bath Ankylosing Spondylitis Functional Index&#8221; &#40;BASFI&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> To measure disease activity&#44; we considered the following quantitative variables&#58; erythrocyte sedimentation rate &#40;ESR&#41;&#44; C-reactive protein &#40;CRP&#41; and the self-completion of the &#8220;Bath Ankylosing Spondylitis Disease Activity Index&#8221; &#40;BASDAI&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Each patient underwent anteroposterior pelvic X-ray&#44; anteroposterior and lateral lumbar spine and cervical spine X-ray&#44; and were scored according to the &#8220;Bath Ankylosing Spondylitis Radiographic Index &#8211; Spinal&#8221; &#40;BASRI-Spinal&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> which measures structural damage&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical Analysis</span><p id="par0030" class="elsevierStylePara elsevierViewall">We performed a descriptive analysis of the clinical&#44; epidemiological&#44; radiographic and laboratory variables by gender and duration of disease&#46; To do that&#44; variables were stratified into 4 groups &#40;0&#8211;9 years&#44; 10&#8211;19&#44; 20&#8211;39 and 40 years or more of disease progression&#41;&#46; Subsequently&#44; the first subgroup was analyzed by creating a new variable &#40;0&#8211;4 years&#44; 5&#8211;7 and 8&#8211;10 years&#41;&#46; We calculated the mean and standard deviation for quantitative variables and absolute frequencies and percentages for qualitative variables&#46; A bivariate test was performed using the Student&#39;s t test for independent data for quantitative variables and the chi-square test for qualitative variables&#46; The values of &#8220;<span class="elsevierStyleItalic">P</span>&#8221; were adjusted by the Finner test&#46; Subsequently&#44; we performed a univariate factorial ANOVA with a Sidak adjustment for multiple comparisons to establish the differences in BASDAI&#44; BASFI&#44; BASRI&#44; ESR and CRP by gender and duration of disease&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">All contrasts were bilateral and those considered significant had a <span class="elsevierStyleItalic">P</span>&#60;0&#46;05&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Demographic and Clinical Characteristics</span><p id="par0040" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the sociodemographic and clinical differences between men and women with AS of the 1514 patients selected&#46; We found that there were significant differences between both groups in the mean age and the onset of symptoms at inclusion&#44; being lower&#44; in both cases&#44; in men&#46; There were also significant differences in the mean duration of disease&#44; again lower in women&#46; Regarding the existence of a history of AS among first-degree relatives&#44; family forms were more frequent in the female group&#46; For other sociodemographic characteristics there were no differences between the two groups&#44; as occurred in the clinical expression&#44; except for the presence of low back pain&#44; which was more common among men&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Regarding treatment&#44; there was no significant differences between genders in the drugs used previously&#46; At the onset of the disease&#44; the proportion of men using sulfasalazine was greater 87&#46;9&#37; than women &#40;95&#37; CI&#44; 86&#46;26&#8211;89&#46;54&#41; vs 83&#46;3&#37; &#40;95&#37; CI&#44; 81&#46;73&#8211;84&#46;87&#41;&#44; <span class="elsevierStyleItalic">P</span>&#61;0&#46;03&#46; The improvement in pain of those patients taking NSAIDs was significantly more favorable in men&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Disease Activity</span><p id="par0050" class="elsevierStylePara elsevierViewall">To assess disease activity we considered BASDAI&#44; ESR and CRP&#46; Compared to men&#44; women had a higher average BASDAI score&#44; regardless of the time of disease progression&#44; with significant differences in all cases&#44; except in those patients whose disease had a mean time interval of 20&#8211;39 years&#46; This difference was accentuated in the group of 40 or more years of disease progression&#44; where we observed that both the average score of the BASDAI as well as ESR and CRP levels were significantly higher in the women than in the men&#58; BASDAI &#40;cm&#41; 5&#46;25 &#40;2&#46;06&#41; &#40;95&#37; CI&#44; 4&#46;18&#8211;6&#46;32&#41; vs 4&#46;01 &#40;2&#46;39&#41; &#40;95&#37; CI&#44; 3&#46;62&#8211;4&#46;40&#41;&#44; <span class="elsevierStyleItalic">P</span>&#61;&#46;033&#59; ESR &#40;mm&#47;h&#41; 36&#46;56 &#40;26&#46;37&#41; &#40;95&#37;&#44; 29&#44; 14&#8211;43&#46;97&#41; vs 17&#46;85 &#40;17&#46;08&#41; &#40;95&#37; CI&#44; 15&#46;01&#8211;20&#46;70&#41;&#44; <span class="elsevierStyleItalic">P</span>&#60;&#46;001&#44; and CRP &#40;mg&#47;l&#41; of 19&#46;60 &#40;30&#46;44&#41; &#40;95&#37;&#44; 13&#46;39&#8211;25&#46;81&#41; vs 8&#46;42 &#40;10&#46;69&#41; &#40;95&#37; CI&#44; 6&#46;03&#8211;10&#46;81&#41;&#44; <span class="elsevierStyleItalic">P</span>&#61;&#46;001&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Both the average BASDAI score and CRP levels were significantly increased in the men related to the years of disease progression&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Radiographic Results</span><p id="par0060" class="elsevierStylePara elsevierViewall">Radiological findings were more severe in men&#44; with a mean score of 6&#46;66 in BASRI &#8211; spinal &#40;3&#46;47&#41; &#40;95&#37; CI&#44; 6&#46;45&#8211;6&#46;87&#41; vs 4&#46;60 &#40;2&#46;67&#41; &#40;95&#37; CI&#44; 4&#46;33&#8211;4&#46;87&#41; in women&#44; <span class="elsevierStyleItalic">P</span>&#60;&#46;001&#46; Adjusting for the duration of the disease&#44; we found that the mean score of BASRI &#8211; spinal worsened significantly in both groups over the years&#44; resulting in all cases in worse outcomes in men&#46; In the subgroup of 0&#8211;10 years we saw that BASRI &#8211; spinal significantly increased over the years in men&#46; When comparing both groups we confirmed that&#44; from the early stages of the disease&#44; the mean BASRI &#8211; spinal score was higher in men&#44; except in the group of 5&#8211;7 years where there were no differences&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Functional Disability</span><p id="par0065" class="elsevierStylePara elsevierViewall">Globally&#44; the BASFI increased significantly with time of disease progression although we cannot say that there were gender differences&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discussion</span><p id="par0070" class="elsevierStylePara elsevierViewall">The review of previously published studies showed that women have more peripheral arthritis and less axial radiographic changes&#46; In our study&#44; we found no differences in relation to the presence of peripheral involvement by gender&#44; although it did occur relative to axial involvement&#44; being higher in men with a better response to NSAID use&#46; Although our study confirms that men have greater radiographic damage than women&#44; there seems to be an apparent contradiction&#44; since although the structural damage was significantly higher in men functional outcomes are the same in both groups&#46; The study of Grand et al&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> showed no gender differences in mobility of the spine&#46; Furthermore Dagfinrud et al&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> found that changes in the mobility of the spine did not explain the observed differences in function&#59; furthermore&#44; the relationship between the radiographic structural damage and loss of function remains unknown&#46; Even in the rheumatoid arthritis studies that have examined this question more fully&#44; the nature of the relationship between the radiographic damage and functional loss is controversial&#44; and may vary over the time course of the disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#8211;16</span></a> This discrepancy between radiological damage and functional loss may be the result of women having more peripheral arthritis&#46; The prevalence of HLA B27 among women with AS is equivalent to that of men&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> From the data obtained in our study of the Spanish population we can conclude that there are differences in the clinical and radiographic findings of SA by gender&#46; We observed that men show more structural damage than women with similar time since onset of the disease&#46; Damage also increases with the progression of the disease regardless of gender&#46; Although radiographic damage is lower in women&#44; this group exhibits greater activity&#46; These data suggest that the AS phenotype differs between genders and may influence the subsequent diagnostic and therapeutic choices&#46; Regarding genetic data&#44; there were no differences in the presence of positivity for HLA-B27&#44; although women had more first-degree family history&#44; which may suggest a different type of inheritance pattern in relation to gender</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Ethical Responsibilities</span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Protection of People and Animals</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors declare that procedures conformed to the ethical standards of the committee responsible for human experimentation and were in accordance with the World Medical Association Declaration of Helsinki&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Data Confidentiality</span><p id="par0080" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their workplace regarding the publication of data from patients and all patients included in the study have received sufficient information and gave their written informed consent to participate in this study&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Right to Privacy and Informed Consent</span><p id="par0085" class="elsevierStylePara elsevierViewall">The authors have obtained informed consent from patients and&#47;or subjects referred to in the article&#46; This document is in the possession of the corresponding author&#46;</p></span></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Conflict of Interest</span><p id="par0090" class="elsevierStylePara elsevierViewall">The authors have no disclosures to make&#46;</p></span></span>"
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    "fechaAceptado" => "2012-09-19"
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            0 => "Ankylosing spondylitis"
            1 => "Bath Ankylosing Spondylitis Radiographic Index Spine"
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            0 => "Espondilitis anquilosante"
            1 => "Bath Ankylosing Spondylitis Radiographic Index Spine"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To describe the differential characteristics by gender and time since disease onset in patients diagnosed with ankylosing spondylitis &#40;AS&#41; attending the Spanish rheumatology clinics&#44; including those on the &#8220;Spanish Registry of spondyloarthritis&#8221; &#40;REGISPONSER&#41;&#44; as well as the diagnostic and therapeutic implications that this entails&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This is a transversal and observational study of 1514 patients with AS selected from 2367 spondyloarthritis cases included in REGISPONSER&#46; For each patient&#44; the demographics&#44; epidemiology&#44; geriatric&#44; clinical&#44; laboratory&#44; radiological&#44; and therapeutic aspects were evaluated and comprehensively recorded under the aegis of REGISPONSER&#44; constituting the Minimum Basic identifying data for the disease&#46; Physical function was assessed by Bath Ankylosing Spondylitis Functional Index &#40;BASFI&#41;&#46; Clinical activity was evaluated using erythrocyte sedimentation rate&#44; C reactive protein and Bath Ankylosing Spondylitis Disease Activity Index &#40;BASDAI&#41;&#46; Each patient underwent pelvic anteroposterior&#44; anteroposterior and lateral lumbar spine as well as lateral cervical spine X-ray&#59; they were scored according to the Bath Ankylosing Spondylitis Spine Radiographic Index&#44; which measures structural damage&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Of the 1514 patients screened&#44; 1131 &#40;74&#46;7&#37;&#41; were men&#46; We found significant differences in age at onset of symptoms as well as in the day of inclusion&#44; between the two groups&#44; being lower in men&#46; We also obtained differences in the duration of the disease&#44; which was lower in women&#46; As for the existence of a history of AS among first-degree relatives&#44; family forms were more common among women&#46; The mean BASDAI score was also higher in women&#44; regardless of time since onset of disease&#46; In contrast&#44; the improvement of pain with the use of NSAID&#39;s and radiological severity were higher in men&#44; both reaching statistical significance&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Among the Spanish AS patients&#44; there are some differences in the clinical manifestations&#44; even when the time since onset of disease was controlled&#59; we also found radiological differences by gender&#59; men showing more structural damage&#44; while women were more active&#46; These data suggest that the phenotype of AS differs between genders&#46; This can influence the subsequent diagnostic approach and therapeutic decisions&#46;</p>"
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      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Establecer las caracter&#237;sticas diferenciales seg&#250;n el sexo y el tiempo de evoluci&#243;n de la enfermedad en aquellos pacientes diagnosticados de espondilitis anquilosante &#40;EA&#41; asistidos en consultas de reumatolog&#237;a de toda Espa&#241;a&#44; incluidos en el Registro Espa&#241;ol de Espondiloartritis &#40;REGISPONSER&#41;&#44; as&#237; como la repercusi&#243;n diagn&#243;stica y terap&#233;utica que ello conlleva&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio transversal y observacional de 1&#46;514 pacientes con EA seleccionados de entre 2&#46;367 con espondiloartritis incluidos en REGISPONSER&#46; En cada paciente se evaluaron y registraron de modo exhaustivo los datos demogr&#225;ficos&#44; epidemiol&#243;gicos&#44; sociosanitarios&#44; cl&#237;nicos&#44; anal&#237;ticos&#44; radiol&#243;gicos y terap&#233;uticos previstos en el protocolo de REGISPONSER que componen el Conjunto M&#237;nimo B&#225;sico que identifica la enfermedad&#46; La funci&#243;n f&#237;sica se evalu&#243; mediante &#171;Bath Ankylosing Spondylitis Functional Index&#187;&#46; La actividad cl&#237;nica mediante velocidad de sedimentaci&#243;n globular&#44; prote&#237;na C reactiva y &#171;Bath Ankylosing Spondylitis Disease Activity Index&#187; &#40;BASDAI&#41;&#46; A cada paciente se le realizaron radiograf&#237;as anteroposterior de pelvis&#44; anteroposterior y lateral de columna lumbar y lateral de columna cervical&#44; y se puntuaron seg&#250;n el &#237;ndice &#171;Bath Ankylosing Spondylitis Radiographic Index Spine&#187; &#40;BASRI-Spine&#41;&#44; que mide el da&#241;o estructural&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">De los 1&#46;514 pacientes seleccionados&#44; 1&#46;131 &#40;74&#44;7&#37;&#41; eran hombres&#46; Encontramos que existen diferencias significativas en la edad tanto al inicio de los s&#237;ntomas como en el d&#237;a de la inclusi&#243;n entre ambos grupos&#44; siendo menor en los hombres&#46; Tambi&#233;n obtuvimos diferencias en el tiempo de evoluci&#243;n de la enfermedad&#44; que fue menor en el grupo de las mujeres&#46; En cuanto a la existencia de antecedentes de EA entre los familiares de primer grado&#44; las formas familiares fueron m&#225;s frecuentes entre las mujeres&#44; tambi&#233;n result&#243; superior en &#233;stas la puntuaci&#243;n media del BASDAI&#44; con independencia del tiempo de evoluci&#243;n&#46; Por el contrario&#44; la mejor&#237;a del dolor con la toma de antiinflamatorios no esteroideos fue mayor en el caso de los hombres&#44; as&#237; como la severidad radiol&#243;gica&#44; ambas de forma significativa&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Entre los pacientes con EA espa&#241;oles existen algunas diferencias en las manifestaciones cl&#237;nicas y cuando se control&#243; seg&#250;n el tiempo de evoluci&#243;n&#44; tambi&#233;n encontramos diferencias radiol&#243;gicas seg&#250;n el sexo&#59; los hombres muestran m&#225;s da&#241;o estructural&#44; mientras que las mujeres presentan mayor actividad&#46; Estos datos sugieren que el fenotipo de EA difiere entre g&#233;neros&#44; lo que puede influir en el manejo diagn&#243;stico y posterior elecci&#243;n terap&#233;utica&#46;</p>"
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    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as&#58; Ortega Castro R&#44; et al&#46; Diferente expresi&#243;n cl&#237;nica de los pacientes con espondilitis anquilosante seg&#250;n el sexo en funci&#243;n del tiempo de evoluci&#243;n&#46; Datos de REGISPONSER&#46; Reumatol Clin&#46; 2013&#59;9&#58;221&#8211;5</p>"
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          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The data show the mean&#177;SD for quantitative variables and absolute frequencies &#40;&#37;&#41; for qualitative variables&#46;</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">AS&#58; Ankylosing spondylitis&#59; HLA&#58; human leukocyte antigen&#59; LL&#58; lower limbs&#59; UL&#58; upper limbs&#59; NS&#58; not significant&#46;</p>"
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  """
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                      "titulo" => "Registro Nacional de Pacientes con Espondiloartropat&#237;as &#40;REGISPONSER&#41;&#46; An&#225;lisis descriptivo de los 2367 pacientes espa&#241;oles incluidos"
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                            2 => "E&#46; Mu&#241;oz Gom&#225;riz"
                            3 => "E&#46; Collantes"
                            4 => "P&#46; Zarco"
                            5 => "C&#46; Gonzalez Fern&#225;ndez"
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Article information

ISSN: 21735743
Original language: English

DOI:10.1016/j.reumae.2012.09.004

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Year/Month	Html	Pdf	Total

2024 November	10	18	28
2024 October	27	36	63
2024 September	50	30	80
2024 August	47	32	79
2024 July	41	24	65
2024 June	46	37	83
2024 May	41	30	71
2024 April	37	24	61
2024 March	42	22	64
2024 February	67	23	90
2024 January	21	17	38
2023 December	19	41	60
2023 November	29	34	63
2023 October	72	24	96
2023 September	62	35	97
2023 August	34	17	51
2023 July	27	23	50
2023 June	34	26	60
2023 May	37	23	60
2023 April	12	15	27
2023 March	51	22	73
2023 February	31	33	64
2023 January	33	19	52
2022 December	48	29	77
2022 November	54	26	80
2022 October	34	40	74
2022 September	38	25	63
2022 August	39	46	85
2022 July	27	42	69
2022 June	44	33	77
2022 May	32	47	79
2022 April	40	51	91
2022 March	40	51	91
2022 February	49	41	90
2022 January	33	34	67
2021 December	30	41	71
2021 November	32	43	75
2021 October	49	38	87
2021 September	27	43	70
2021 August	33	40	73
2021 July	24	33	57
2021 June	30	26	56
2021 May	40	36	76
2021 April	65	64	129
2021 March	71	25	96
2021 February	42	28	70
2021 January	27	27	54
2020 December	24	14	38
2020 November	24	12	36
2020 October	25	8	33
2020 September	39	18	57
2020 August	36	11	47
2020 July	17	16	33
2020 June	26	13	39
2020 May	28	12	40
2020 April	39	13	52
2020 March	18	9	27
2020 February	1	0	1
2019 April	2	0	2
2019 January	1	0	1
2018 May	4	3	7
2018 April	31	9	40
2018 March	46	8	54
2018 February	27	7	34
2018 January	26	11	37
2017 December	39	8	47
2017 November	33	12	45
2017 October	27	9	36
2017 September	39	6	45
2017 August	53	4	57
2017 July	56	11	67
2017 June	68	19	87
2017 May	41	11	52
2017 April	27	6	33
2017 March	27	6	33
2017 February	28	7	35
2017 January	32	5	37
2016 December	73	17	90
2016 November	60	5	65
2016 October	88	15	103
2016 September	68	6	74
2016 August	69	10	79
2016 July	38	6	44
2016 May	2	16	18
2016 January	2	0	2
2015 December	3	0	3
2015 October	1	21	22
2015 September	1	16	17
2015 July	31	6	37
2015 June	47	13	60
2015 May	65	22	87
2015 April	59	14	73
2015 March	50	18	68
2015 February	51	15	66
2015 January	50	11	61
2014 December	52	9	61
2014 November	44	12	56
2014 October	53	15	68
2014 September	29	12	41
2014 August	31	16	47
2014 July	38	21	59
2014 June	61	25	86
2014 May	46	20	66
2014 April	90	19	109
2014 March	68	20	88
2014 February	69	19	88
2014 January	70	13	83
2013 December	45	13	58
2013 November	28	15	43
2013 October	55	10	65
2013 September	49	26	75
2013 August	81	42	123
2013 July	35	20	55

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