OBJECTIVES: To investigate sex differences in patient-reported outcome measures (PROMs) among axSpA patients initiating their first TNFi and identify factors contributing to these disparities over the follow-up. METHODS: Data were included from 15 EuroSpA registries and consisted of axSpA patients initiating their first TNFi, with ≥2 measurements for each analysed PROM (BASDAI and BASFI, scale 0-100) taken at any time point. Linear mixed models were employed to analyse sex differences in PROMs over 24 months and to evaluate how baseline characteristics were related to the observed sex differences. RESULTS: We analysed 13 102 (38% women) in the BASDAI analyses and 10 623 (38% women) in the BASFI analyses. At follow-up, mean sex differences in BASDAI increased from 4.3 units at baseline (95% CI, 3.5-5.1) to 8.0 (7.2-8.8) at 6 months, and in BASFI from 2.2 (1.4-3.1) to 4.6 (3.6-5.5), with consistently worse scores in women. Baseline characteristics could not substantially account for the observed sex differences over time; however, the magnitude of the sex differences was reduced by HLA-B27 positivity, longer disease duration, and increased CRP levels, but increased by TNFi initiation in later years and peripheral arthritis. CONCLUSION: In axSpA patients initiating their first TNFi, baseline sex differences in BASDAI and BASFI increased two-fold after 6 months of treatment and persisted thereafter, with worse scores in women. Several baseline characteristics moderated the sex differences, though none could fully account for them. These findings improve our understanding of sex differences and underscore their importance in axSpA.

Aberdeen Centre for Arthritis and Musculoskeletal Health University of Aberdeen Aberdeen UK

Amsterdam Rheumatology and Immunology Center Amsterdam Netherlands

Amsterdam Rheumatology and Immunology Center Reade and Amsterdam UMC Amsterdam Netherlands

Center for Rheumatic Diseases University of Medicine and Pharmacy Bucharest Romania

Center for Treatment of Rheumatic and Musculoskeletal Diseases Diakonhjemmet Hospital Oslo Norway

Centre for Rheumatology Research Landspitali University Hospital Reykjavik Iceland

Copenhagen Center for Arthritis Research Center for Rheumatology and Spine Diseases Centre for Head and Orthopaedics Rigshospitalet Glostrup Denmark

DANBIO and Copenhagen Center for Arthritis Research Center for Rheumatology and Spine Diseases Centre for Head and Orthopaedics Rigshospitalet Glostrup Denmark

DANBIO and Department of Rheumatology Aarhus University Hospital Aarhus Denmark

Department of Clinical Immunology and Rheumatology Amsterdam UMC Location AMC Free University of Amsterdam Amsterdam Netherlands

Department of Clinical Immunology and Rheumatology Amsterdam UMC Location AMC Netherlands Amsterdam

Department of Clinical Immunology and Rheumatology Amsterdam UMC Location AMC University of Amsterdam Amsterdam Netherlands

Department of Clinical Medicine Aarhus University Aarhus Denmark

Department of Clinical Medicine University of Copenhagen Copenhagen Denmark

Department of Clinical Sciences Lund Rheumatology Skåne University Hospital Lund University Lund Sweden

Department of Epidemiology and Data Science Amsterdam UMC Amsterdam Netherlands

Department of Medicine Helsinki University and Helsinki University Hospital Helsinki Finland

Department of Medicine Surgery and Neurosciences Rheumatology Unit University of Siena Siena Italy

Department of Rheumatology 1st Faculty of Medicine Charles University Prague Czech Republic

Department of Rheumatology Geneva University Hospital Geneva Switzerland

Department of Rheumatology Hospital General Universitario Gregorio Marañón Madrid Spain

Department of Rheumatology Radboud University Medical Center Nijmegen Netherlands

Department of Rheumatology University Hospital Zurich University of Zurich Zurich Switzerland

Department of Rheumatology University Medical Centre Ljubljana Ljubljana Slovenia

Departments of Medicine and Rheumatology Helsinki University Hospital Helsinki Finland

Division of Rheumatology Department of Internal Medicine Dokuz Eylul University School of Medicine Izmir Turkey

Faculty of Medicine Complutense University of Madrid Madrid Spain

Faculty of Medicine University of Iceland Reykjavik Iceland

Faculty of Medicine University of Ljubljana Ljubljana Slovenia

Institute of Rheumatology Prague Czech Republic

Instituto Medicina Molecular Faculdade de Medicina da Universidade de Lisboa Centro Académico de Medicina de Lisboa Lisbon Portugal

Research Unit Sørlandet Hospital Kristiansand Norway

Research Unit Spanish Society of Rheumatology Madrid Spain

Reuma pt and Department of Rheumatology Hospital Garcia de Orta Almada Portugal

Rheumatology Unit DiMePRe J University of Bari Bari Italy

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