Photo Credit: Andranik Hakobyan

A recent survey reveals gender-based differences in how patients perceive PsA treatment and symptoms, as well as communication with healthcare providers.

Psoriatic arthritis (PsA) impacts men and women, but not always in the same way. A recent article in Rheumatology and Therapy details how gender may impact perceptions of PsA severity and management, interactions with healthcare providers (HCPs), and health-related QOL.

To gather data, Lihi Eder, MD, PhD, and colleagues analyzed results from 1,286 individuals with PsA who participated in a self-reported survey. The researchers concluded that gender impacts perceptions of communication with HCPs and how PsA is experienced.

“This analysis of data from a global online survey suggests that the burden of PsA is greater for females than males, with more females reporting a major/moderate impact on their physical activity and emotional/mental well-being,” the researchers stated.

Understanding the Patient Population

PsA impacts both sexes, though questions remain on how gender influences an individual’s perception of the disease and its impact on daily life.

To answer some of these questions, Dr. Eder and colleagues conducted a survey using the Harris Poll on behalf of Pfizer. Survey respondents resided in the US, UK, Taiwan, Australia, Brazil, Canada, France, and Spain.

To be eligible, patients had to be 18 years or older, self-report a PsA diagnosis lasting one year or longer, visit a rheumatologist or dermatologist within the past twelve months, and have previously used a conventional synthetic or biologic disease-modifying antirheumatic drug (DMARD) for PsA.

52% of survey respondents identified as female and 48% as male, with average ages of 41.3 and 41.0, respectively. The average time since PsA diagnosis was 9.2 years for women and 8.8 years for men. Survey respondents reported taking multiple PsA medications, including biologics, DMARDs, NSAIDs, steroids, and other medications or combinations of these prescriptions.

Symptoms Reported by Patients

Both genders reported experiencing a range of PsA symptoms. Joint pain was the most common overall, while skin and nail symptoms were skin patches and plaques. 56% of women and 48% of men also reported unusual fatigue.

91% of all respondents experienced symptoms while taking medication. When asked about symptoms experienced while on medication, the most common responses were:

• Musculoskeletal symptoms (54% of women, 51% of men)
• Skin patches or plaques (43% of women, 36% of men)
• Joint tenderness (43% of women, 36% of men)
• Enthesitis (30% of women, 24% of men)

Despite these similarities, different symptoms inspired men and women to see HCPs. Women were more likely to visit an HCP when they experienced musculoskeletal symptoms, such as joint swelling or swollen fingers, or when they had to cover up skin around others. Men were likely to visit an HCP due to difficulty participating in sports or recreational activities.

Physical Activity and PsA

The majority of survey respondents reported physical activity as the area most impacted by PsA. 81% of women and 75% of men reported that their physical activity was limited due to this condition, though men were more likely to see a doctor.

56% of women reported they stopped participating in a physical activity or sport after their PsA diagnosis. 55% of men reported the same. Similar amounts of men and women reported difficulty at work or in school due to PsA. Men were more likely to worry about how PsA impacted their ability to work (42% vs 31%, respectively).

Mental Wellbeing and PsA

PsA also impacted respondents’ emotional and mental well-being. More specifically, 73% of women and 65% of men reported negative mental health impacts. However, men were 37.9% less likely to report the mental impact of PsA as moderate or severe.

With regards to social health, both men and women reported that PsA caused difficulties in relationships with friends, family and romantic partners. Yet, these social difficulties may impact women more. 34% of female respondents reported feeling social shame due to PsA (compared with 31% of male respondents).

Patient Perceptions of PsA Treatment

Contrary to previous studies, Eder and researchers found women were less likely to report switching medications than men. They also found relieving musculoskeletal symptoms was more important for women, while men reported wanting to change medication more often due to frequent doses.

Survey respondents were also asked if they had goals for their PsA treatment. If they answered yes, they were asked to define them. 21% of women and 16% of men said putting PsA into remission was important. Up to 7% of men and 4% of women reported a desire to increase physical activity, while 5% of women and 2% of men wanted to reduce stiffness.

Three percent of women and 1% of men identified a desire to switch from injections or infusions to oral medications as a goal. Interestingly, 37% reported switching medications within the last two years. Women were less likely to switch than men (34% to 41%, respectively).

Reasons reported for switching medication included:

• Joint symptoms not improving or getting worse (41% of men, 28% of women)
• Concerns for potentially serious adverse effects (20% of men, 16% of women)
• Symptoms being under control (18% of men, 9% of women)
• Medication interrupting daily routine (16% of men, 8% of women)
• Did not like taking pills (15% of men, 5% of women)

Communication With Clinicians

Most survey respondents were “somewhat satisfied” or “very satisfied” with their dermatologist or rheumatologist. Women were likelier to report feeling very satisfied, while men experienced lower satisfaction levels.

The most common topics discussed with HCPs were:

• Treatment goals (83% of women, 78% of men)
• Impact of PsA on their ability to conduct daily activities (82% of women, 73% of men)
• Response to or satisfaction with their treatment regimen (81% of women, 72% of men)

Overall, men were less likely to openly discuss PsA with clinicians. The researchers suggested that focusing on effective communication and shared decision-making with patients may help deliver better treatment outcomes.

The researchers concluded, “When treating patients, it is important for HCPs to consider the potential impact of gender on patients’ experience of PsA and its symptoms.”