A Gender-based Analysis of Disease Activity and Its Relationship with Anxiety, Depression, Fatigue, and Fibromyalgia in Psoriatic Arthritis

Background/Purpose: This study sought to compare the disease activity and its relationship with anxiety, depression, fatigue, and fibromyalgia of patients with psoriatic arthritis (PsA) between female and male gender in a Turkish population. Methods: This multi-center Turkish League Against Rheumatism (TLAR) Network study included 1134 patients (726 females, 408 males) diagnosed with PsA according to the CASPAR criteria. Demographic and clinic parameters of the patients were recorded. Disease activity was evaluated using the scores of DAS28, DAPSA, cDAPSA, MDA, VLDA, and BASDAI. Health Assessment Questionnaire (HAQ), SF-36, Hospital Anxiety and Depression Scale (HAD), fatigue VAS (0-10), and Fibromyalgia Rapid Screening Tool (FIRST) were assessed. Disease activity and remission rates were compared in male and female patients, and their relationship with fatigue, anxiety, depression, and fibromyalgia scores was analyzed. The Spearman correlation coefficient was used to assess correlations. Comparisons were made using the Mann-Whitney U and chi-squared tests. p< 0.05 was considered significant. Results: The mean age of the patients was 47.4 years (SD:12.1) for females, 46 years (SD:12.2) for males (Table-1). Disease activity scores of DAS28, DAPSA, cDAPSA, and BASDAI were significantly higher in women than in men (p< 0.05) (Table-2), with men having both higher remission and low-activity rates. There was a significant difference in the rate of MDA in favor of men (p< 0.05), but not in the rate of VLDA. The frequencies of dactylitis, enthesitis, inflammatory bowel disease, and arthritis were similar in men and women, while men had a higher incidence of spondylitis (p< 0.05). Both men and women with MDA had significant improvements in the scores of fatigue, HAQ, FIRST, anxiety and depression as well as in SF-36 subscales as compared with their counterparts without MDA (p< 0.05). Overall, although there was no significant between-group difference in age, body mass index, and disease duration, women had significantly higher anxiety, depression, and FIRST scores (fibromyalgia) compared with men (p< 0.05) (Table-2). In both men and women, disease activity scores of DAPSA, DAS28, and BASDAI were significantly correlated with the scores of FIRST, anxiety, depression, fatigue, and HAQ (p< 0.05). Conclusion: In patients with PsA, women seem to have lower levels of remission and higher levels of disease activity than men. In both women and men, disease activity scores are significantly correlated with fatigue, functional status, anxiety, depression, fibromyalgia, and quality of life.