{
  "abstract": "Objective The primary objective was to assess sex differences in long-term functional deterioration and permanent work disability in spondyloarthritis (SpA), and the secondary aim to evaluate whether systemic inflammation mediates the association between biologic disease-modifying antirheumatic drugs (bDMARDs) exposure and functional change in a sex-dependent manner.Methods A longitudinal observational study was conducted in 411 patients with SpA from the Spanish REGISPONSER registry (baseline 2004–2007), who were reassessed 17 years later in REGISPON-3 (2021–2024). Outcomes were Bath Ankylosing Spondylitis Functional Index (BASFI) at follow-up, ΔBASFI and permanent work disability. Sex-stratified logistic and multivariable linear regression models were used. Moderated mediation analysis evaluated C reactive protein (CRP) as a mediator of the association between bDMARD exposure and ΔBASFI, with sex as a moderator.Results A total of 271 male patients with SpA (65.9%) and 140 female patients with SpA (34.1%) were included. At follow-up, female patients showed significantly worse functional status and greater functional deterioration (ΔBASFI 1.47±2.81 vs 0.38±2.57, p<0.001), whereas permanent disability rates were similar (27.1% vs 32.1%, p=0.31). Higher Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Radiology Index (BASRI)-total were independently associated with disability in both sexes. Baseline BASFI and BASDAI predicted ΔBASFI in both sexes; additional predictors in male patients included BASRI-total and occiput-to-wall distance, whereas BASRI-column was relevant in female patients. The indirect effect of bDMARD exposure on ΔBASFI through CRP was significant in male patients but not in female patients with a significant sex interaction.Conclusion Female patients experienced greater long-term functional deterioration despite similar work disability rates at follow-up. The relationship between systemic inflammation and long-term functional outcomes may differ by sex.",
  "authors": [
    {
      "affiliations": [
        "2nd Internal Medicine Department, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania",
        "Medical and Surgical Sciences Department, University of Cordoba, Córdoba, Spain"
      ],
      "name": "Diana Maria Margareta Moldovan"
    },
    {
      "affiliations": [
        "Medical and Surgical Sciences Department, University of Cordoba, Córdoba, Spain",
        "Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain",
        "Rheumatology Department, Reina Sofia University Hospital, Córdoba, Spain"
      ],
      "name": "Lourdes Ladehesa-Pineda"
    },
    {
      "affiliations": [
        "Medical and Surgical Sciences Department, University of Cordoba, Córdoba, Spain",
        "Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain",
        "Rheumatology Department, Reina Sofia University Hospital, Córdoba, Spain"
      ],
      "name": "María Ángeles Puche-Larrubia"
    },
    {
      "affiliations": [
        "Medical and Surgical Sciences Department, University of Cordoba, Córdoba, Spain",
        "Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain",
        "Rheumatology Department, Reina Sofia University Hospital, Córdoba, Spain"
      ],
      "name": "María Carmen Ábalos-Aguilera"
    },
    {
      "affiliations": [
        "Medical and Surgical Sciences Department, University of Cordoba, Córdoba, Spain",
        "Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain",
        "Rheumatology Department, Reina Sofia University Hospital, Córdoba, Spain"
      ],
      "name": "Desirée Ruiz-Vilchez"
    },
    {
      "affiliations": [
        "Medical and Surgical Sciences Department, University of Cordoba, Córdoba, Spain",
        "Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain",
        "Rheumatology Department, Reina Sofia University Hospital, Córdoba, Spain"
      ],
      "name": "Raquel Ena Granados"
    },
    {
      "affiliations": [
        "Medical and Surgical Sciences Department, University of Cordoba, Córdoba, Spain"
      ],
      "name": "Carlos M Collantes-Sánchez"
    },
    {
      "affiliations": [
        "Medical and Surgical Sciences Department, University of Cordoba, Córdoba, Spain",
        "Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain",
        "Rheumatology Department, Reina Sofia University Hospital, Córdoba, Spain"
      ],
      "name": "Alejandro Escudero-Contreras"
    },
    {
      "affiliations": [
        "2nd Internal Medicine Department, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania",
        "Medical and Surgical Sciences Department, University of Cordoba, Córdoba, Spain",
        "Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain",
        "Rheumatology Department, Reina Sofia University Hospital, Córdoba, Spain"
      ],
      "name": "REGISPON-3 Study Group"
    },
    {
      "affiliations": [
        "Medical and Surgical Sciences Department, University of Cordoba, Córdoba, Spain",
        "Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain"
      ],
      "name": "Eduardo Collantes-Estévez"
    },
    {
      "affiliations": [
        "Medical and Surgical Sciences Department, University of Cordoba, Córdoba, Spain",
        "Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain",
        "Rheumatology Department, Reina Sofia University Hospital, Córdoba, Spain"
      ],
      "name": "Clementina López-Medina"
    }
  ],
  "title": "Sex differences in long-term functional deterioration and permanent disability in spondyloarthritis: a 17-year follow-up from the REGISPON-3 study",
  "uid": "aa499260-a827-5781-840d-5b2907609e49"
}