FRI0315 GENDER DIFFERENCES IN PATIENT JOURNEY TO DIAGNOSIS AND PATIENT-REPORTED OUTCOMES: RESULTS FROM THE EUROPEAN MAP OF AXIAL SPONDYLOARTHRITIS (EMAS)
Authors: M. Garrido-Cumbrera, D. Poddubnyy, L. Gossec, R. Mahapatra, C. Bundy, S. Makri, S. Sanz-Gómez, L. Christen, C. J. Delgado-Domínguez, V. Navarro-Compán
Journal: Annals of the Rheumatic Diseases (2020)

Background: Growing evidence of similarities in male-female prevalence of axial spondyloarthritis (axSpA) has stimulated the need to evaluate gender differences in patient experiences. Objectives: To evaluate gender differences in diagnostic journey, disease-characteristics and patient-reported outcomes (PROs) in axSpA patients. Methods: Data from 2846 unselected patients of the European Map of Axial Spondyloarthritis (EMAS) through an online survey (2017-2018) across 13 countries were analysed. Socio-demographic characteristics, diagnosis, disease-characteristics, and PROs [BASDAI (0-10), spinal stiffness (3-12), functional limitation (0-54) and psychological distress (0-12, GHQ-12)] were compared between genders. Χ 2 (for categorical variables) and student-t (for continuous variables) were employed. Results: 1,746 (61.3%) females participated in the EMAS, with homogeneous gender distribution across most countries (Fig 1). Compared to males, females reported longer diagnostic delay (6.1±7.4 vs 8.2±8.9; p&lt;0.001), more visits to physiotherapists (34.5% vs 49.5%; p&lt;0.001) and osteopaths (13.3% vs 24.4%; p&lt;0.001) before being diagnosed (Table 1), higher disease activity in all BASDAI items and greater functional limitation, psychological distress and self-reported anxiety and depression (Table 2). Table 1. Disease characteristics by gender (N: 2846, unless specified) Men (n: 1100) (mean ± SD or %) Women (n: 1746) (mean ± SD or %) p value Age at onset of first symptoms, n: 2721 27.0 ± 11.8 26.4 ± 10.7 0.342 Age at diagnosis, n: 2722 32.6 ± 12.2 34.4 ± 10.9 &lt;0.001 Diagnostic delay, n: 2652 6.1 ± 7.4 8.2 ± 8.9 &lt;0.001 Disease Duration, n: 2716 18.9 ± 13.3 16.1 ± 11.7 &lt;0.001 HCP seen before diagnosis - General practitioner 822 (74.7) 1434 (82.1) &lt;0.001 - Orthopaedic specialist 377 (34.3) 557 (31.9) 0.190 - Physiotherapist 380 (34.5) 865 (49.5) &lt;0.001 - Osteopath, n: 2166 103 (13.3) 339 (24.4) &lt;0.001 - Other, n: 2220 135 (14.0) 233 (18.5) 0.005 Family history of axSpA (yes), n: 2244 291 (33.5) 584 (42.5) &lt;0.001 HLA-B27 (positive), n: 1799 497 (80.2) 786 (66.7) &lt;0.001 Uveitis (yes), n: 2096 199 (25.2) 270 (20.7) 0.023 IBD (yes), n: 2096 113 (14.3) 181 (13.9) 0.688 Table 2. PROs by gender (N: 2846, unless specified) Men (n: 1100) (mean ± SD or %) Women (n: 1746) (mean ± SD or %) p value BASDAI, (0-10) n: 2584 5.1 ± 2.0 5.7 ± 1.9 &lt;0.001 - Fatigue, n: 2636 5.7 ± 2.4 6.6 ± 2.2 &lt;0.001 - Neck, back or hip pain, n: 2636 5.6 ± 2.4 6.2 ± 2.2 &lt;0.001 - Pain other than neck, back or hip, n: 2636 4.3 ± 2.7 4.9 ± 2.6 &lt;0.001 - Discomfort to touch or pressure, n: 2636 4.5 ± 2.7 5.6 ± 2.6 &lt;0.001 - Morning stiffness level, n: 2636 5.3 ± 2.6 5.9 ± 2.6 &lt;0.001 - Morning stiffness duration, n: 2584 4.5 ± 2.8 4.7 ± 2.8 0.070 Stiffness, (3-12) n: 2707 7.7 ± 2.6 7.8 ± 2.4 0.107 Functional Limitation, (0-54) n: 2771 19.1 ± 16.7 21.2 ± 16.0 &lt;0.001 GHQ-12 ≥3, n: 2640 564 (55.4) 1060 (65.4) &lt;0.001 Anxiety 243 (30.6) 566 (43.3) &lt;0.001 Depression 238 (30.1) 472 (36.1) &lt;0.001 Figure 1. Countries’ sample distribution stratified by gender (N: 2846) Conclusion: Important gender differences are observed in axSpA such as a longer patient journey to diagnosis, poorer PROs, and greater psychological burden in females. These results point to unmet needs in females with axSpA, requiring particular attention. Acknowledgments: Funded by Novartis Pharma AG Disclosure of Interests: Marco Garrido-Cumbrera: None declared, Denis Poddubnyy Grant/research support from: AbbVie, MSD, Novartis, and Pfizer, Consultant of: AbbVie, Bristol-Myers Squibb, Eli Lilly, MSD, Novartis, Pfizer, Roche, UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Eli Lilly, MSD, Novartis, Pfizer, Roche, UCB, Laure Gossec Grant/research support from: Lilly, Mylan, Pfizer, Sandoz, Consultant of: AbbVie, Amgen, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Sandoz, Sanofi-Aventis, UCB, Raj Mahapatra: None declared, Christine Bundy Grant/research support from: Has received unrelated honoraria from Abbvie, Celgene, Janssen, Lilly, Novartis, and Pfizer., Souzi Makri: None declared, Sergio Sanz-Gómez: None declared, Laura Christen: None declared, Carlos Jesús Delgado-Domínguez: None declared, Victoria Navarro-Compán Consultant of: Abbvie, Lilly, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, MSD, Lilly, Novartis, Pfizer, UCB