Abstracts Highlight Sex-Based Differences in IA Management

Two abstracts presented at EULAR 2022 focused on sex-related differences in inflammatory arthritis (IA) management, from adherence of electronically reporting outcomes to disparities in health care utilization.

Sex-Related Differences in Telemonitoring IA Disease Activity

Electronic patient reported outcome measures (ePROMs) can be used to track IA disease activity between consultations. However, recent data suggest long-term adherence to this telemonitoring method is declining.¹

To better understand the cause of this decline, researchers enrolled 220 patients with RA, with a mean age of 54 and median disease duration of 9 years. Of this group, 99 patients had rheumatoid arthritis (RA), 81 had psoriatic arthritis (PsA), and 40 had ankylosing spondylitis (AS).

The researchers found a 42% drop in adherence to the ePROM app between week 1 (81%) and week 26 (39%), noting a median dropout period at 17 weeks. Additionally, 141 (64%) participants stopped telemonitoring their IA disease activity.

Women were more likely to drop out (HR, 1.6; P = .02) and stopped reporting to the app sooner compared with men. According to the authors, this contradicts prior research.

Patients who adhered to the ePROM app throughout the study reported a higher usability of the app (82) compared with patients who dropped out before the 6-month mark, with participants who dropped out within the first month rating usability the lowest (68).

The authors said further research is needed to understand why women dropped out sooner and if the usability of ePROMs is causally associated with adherence.

Sex-Related Disparities in Health Care Utilization for IA

Delayed IA diagnosis is associated with joint damage and disability, making regular and timely IA assessments important to achieve favorable disease outcomes. Further, biological and sociocultural factors are known to play a role in clinical and patient behavioral patterns.

To compare patterns of musculoskeletal (MSK)-related health care utilization before and after IA diagnosis between male and female patients, the authors analyzed data from 3 cohorts: 41,277 patients with RA; 8150 patients with AS; and 6446 patients with PsA.²

Females made up the majority of all 3 disease state cohorts and were more likely to have multimorbidity, osteoporosis, and depression. The authors also found that cardiovascular disease was more common among male patients across all 3 groups.

In terms of patient behavior, females were more likely to visit a rheumatologist or family physician vs males, especially earlier on before IA diagnosis. Males, however, were more likely to visit an emergency department immediately prior to diagnosis.

Additionally, male and female patients were prescribed disease-modifying antirheumatic drugs (DMARDs) at similar rates across all 3 IA disease states. However, more female patients with AS received a conventional synthetic DMARD compared with male patients with AS, and females with RA were more likely to use nonsteroidal anti-inflammatory drugs and opioids than males with RA.

According to the authors, females with IA across all 3 cohorts had higher MSK-related health care utilization, which suggests there may be sex-based differences playing a role in the IA disease course or health care seeking behavior.

Reference

1. Wiegel J, Seppen B, Ter Wee M, Nurmohamed M, Bos H. Adherence to telemonitoring disease activity by electronic patient reported outcomes in patients with inflammatory arthritis: a prospective cohort study. Presented at: EULAR 2022; June 1-4, 2022; Copenhagen, Denmark. Abstract POS0158.

2. Tarannum S, Widdifield J, Wu F, Johnson S, Rochon P, Eder L. Sex-related disparities in healthcare utilization in patients with inflammatory arthritis: a population-based study. Presented at: EULAR 2022; June 1-4, 2022; Copenhagen, Denmark. Abstract POS0159.