Considering the Patient Perspective: Challenges Facing Women with Axial Spondyloarthritis and Psoriatic Arthritis

Abstract

This symposium took place during the 2019 European League Against Rheumatism (EULAR) congress in Madrid, Spain, and focussed on the unique challenges facing women with axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA), highlighting differences in diagnosis, disease course, and treatment response between men and women. Compared to men, women have a longer delay to axSpA diagnosis, higher disease activity, lower quality of life, and experience more fatigue, peripheral involvement, and functional impairment, despite less radiological damage and a lower treatment response to biologicals. In addition, axSpA in general is associated with depression, anxiety, reduced work productivity, and an increased risk of adverse pregnancy outcomes. Women with PsA typically present with a higher number of involved joints than men, poorer patient-reported outcomes, and a lower quality of life. They also report higher disability scores, more fatigue, a higher prevalence of depression, and often delay or abandon decisions to start a family or to breastfeed their infants. Although a treat-to-target approach is endorsed by both EULAR and Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) guidelines for the management of PsA, minimal disease activity (MDA) is less frequently achieved by women compared to men. Biologic anti-TNF drugs are efficacious in both SpA and PsA. However, during pregnancy and breastfeeding, most anti-inflammatory biologics used for the management of PsA and SpA are not recommended because of the risk of drug transfer across the placenta to the fetus or via the breastmilk to the infant. Exceptions are the TNF inhibitors adalimumab and certolizumab pegol, a PEGylated Fab’ fragment of a humanised monoclonal antibody, for which use in pregnancy and breastfeeding has been documented by clinical and registry data. In conclusion, efficacious treatment strategies do exist that allow women with axSpA or PsA to achieve satisfactory disease control, also during pregnancy and when breastfeeding.