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OBJECTIVES: Gender differences may modify symptoms, disease expression, and treatment effects. The objective was to evaluate the link between life impact and gender in psoriatic arthritis (PsA). METHODS: ReFlaP (NCT03119805) was a study in 14 countries of consecutive adult patients with definite PsA. Participants underwent comprehensive PsA assessment: Disease Activity in PSoriatic Arthritis (DAPSA), Minimal Disease Activity (MDA), and Psoriatic Arthritis Impact of Disease (PsAID). Disease activity was compared by gender using t-tests or Wilcoxon tests. The association of PsAID with gender was analyzed using hierarchical generalized linear models. RESULTS: Of 458 participants 50.2% were male, mean age (SD) 53.1 (12.6) years, PsA duration 11 (8.2) years, and 51.5% taking bDMARDs. Women versus men had worse Leeds enthesitis index: 0.8 (1.7) / 0.3 (0.9), pain [numerical rating scale 0-10 (NRS)]: 4.7 (2.7) / 3.5 (2.7), HAQ-DI: 0.9 (0.7) / 0.5 (0.6), fatigue NRS: 5.2 (3) / 3.3 (2.8), PsAID: 4.1 (2.4) / 2.8 (2.3), p<0.001 for all, and were less frequently at treatment target (T2T): DAPSA (DAPSA cut-offs ≤4 remission, >4 and ≤14 low disease activity): 16.9 (14.9) / 12.6 (16.6), MDA: 25.7% / 50.0%, p<0.001 for all. High life impact (PsAID≥4) was associated with female gender [odds ratio (OR) 2.3], enthesitis (OR 1.34), tender joints (OR 1.10) p<0.001 for all, and comorbidities (OR 1.22, p=0.002). CONCLUSIONS: High life impact was independently associated with female gender, enthesitis, comorbidities, and tender joints. At T2T, women vs men had higher life impact. Life impact needs to become part of PsA T2T strategies.

Original publication




Journal article


Arthritis care res (hoboken)

Publication Date



gender, life impact, patient reported outcomes, psoriatic arthritis, sex, treatment target