Ankylose This! Living with Ankylosing Spondylitis

Monday, May 07, 2007

Gender differences in ankylosing spondylitis

Via Arthritis, a clinical study examining the influence of gender on the severity of ankylosing spondylitis. The study looked at 302 men and 100 women who had AS for more than 20 years. The women had an earlier onset of disease, were more likely to have a first-degree family member with the disease, and had more peripheral symptoms. But the study also observed the following:

  1. Radiographic spinal damage was worse among men.
  2. Functional disability was the same among men and women.
  3. After adjusting for radiographic spinal damage, women reported worse functioning.
I'm having trouble understanding what that means -- and it's probably beyond the scope of any medical study to infer general conclusions from such data. But these data suggest to me a discrepancy: either the disease is worse in women for a given level of spinal damage (although, on average, the men were in worse shape -- median scores of 10 vs. 6.5 -- just that a woman with 6.5 would report worse functioning than a man with 6.5), in some as-yet unquantifiable way, or women are overreporting/men are underreporting their symptoms.

Something subtler, I hope, than "women bitch more about pain," but I recall a study a few years back -- I'm too tired to look for a link at the moment -- that said that if men and women reported the same amount of pain, the men got more medication for it, on the assumption that women were more likely to complain and men were more likely to suck it up. Now, I'm male and a big wuss and I complain all the time, so I'm leery of stereotypes and would hate to see them confirmed, but you know ... how do you explain worse self-reported functioning for the same observed data?

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Comments on this post

  • First of all, physiological studies have shown that when given an identical pain stimulus, men actually rate their pain higher than do women. Some scientists have conjectured that this higher pain threshold exists for child-birthing reasons, but this hypothesis is highly debatable, and of course, advanced by male physiologists. Secondly, were the radiographs x-rays or MRI's? If they were x-rays, obviously x-rays can clearly depict bone osteophytes and vertebral fusion, but they CANNOT capture tissue inflammation being experienced by the patient. As we know, we can have severe inflammatory symptoms leading to severe discomfort and pain WITHOUT exhibiting significant radiological changes in the vertebral column. It would be my estimation that this is the root of the differences between the radiographs of the men and women whom both reported similar dysfunction.

    Posted by Anonymous Anonymous (5/17/2007 12:42 PM)  

  • When I was diagnosed in 1986, my doctor seemed to think AS was less severe in women, and he understood it to be rare in black women in particular. By 1995, when I had my hips replaced, my doctors pronounced themselves shocked by the degree of my deterioration, especially as a woman. Ten years later, another rheumatologist told me that AS was as common in women as it was in men, but the symptoms are less severe in women. If I remember correctly, he then looked at me as if to say, of course, there are exceptions.

    Here's hoping you all stay supple and pain-free.

    Posted by Blogger Professor Kim (5/26/2007 9:03 PM)  

  • I have read that the fact that women generally have a slower progession of fusion or fuse incompletely actually results in a more painful long term disease. When an area is fused - disease activity usually slows down in that area. So - having more radiographic damage may sometimes mean having less pain at that time. Of course there is still pain from mechanical damage and all of those other nasty problems that go with fusing (breathing, bending, breaking etc).

    I have also recently seen some research that may indicate the inflammation problem and the fusing problem could be seperate parts of AS. Inflammation may not be the main thing causing fusion as was previously thought. So - you could be in really bad shape functioning and pain wise but not have coresponding radiographic evidence to back it up.

    Stupid disease just doesn't seem to work like it is supposed to ever! ;)

    Posted by Anonymous Tommi (A chick with AS) (5/31/2007 8:59 PM)  

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