WORLD JOURNAL OF ADVANCE
HEALTHCARE RESEARCH

( An ISO 9001:2015 Certified International Journal )

An International Peer Review Journal for Medical Science and Pharma Professionals

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  • Index Copernicus
  • SOCOLAR, China
  • Research Bible, Fuchu, Tokyo. JAPAN
  • Cosmos Impact Factor
  • Scientific Indexing Services (SIS)
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Abstract

THE EFFECT OF SEX ON RESPONSE TO TNF INHIBITORS IN A SAMPLE OF IRAQI PATIENTS WITH AXIAL SPONDYLOARTHRITIS: A SINGLE CENTER STUDY

Dr. Ragad Dhaya Jaber*, Dr. Anmar Behnam Bakoz

ABSTRACT

Background: Axial Spondyloarthritis (axSpA) is a chronic inflammatory rheumatic disease predominantly affecting the axial skeleton. Tumor Necrosis Factor-alpha (TNF-α) inhibitors have revolutionized management, but sex-specific variations in treatment response remain under-investigated in Middle Eastern populations. Objectives: To evaluate the effect of sex on baseline disease profiles, functional status, and prospective clinical response to TNF inhibitors at 3 and 6 months among Iraqi axSpA patients. Subjects and Methods: A single-center prospective observational study was conducted at the Rheumatology Unit, Baghdad Teaching Hospital (November 2022 to April 2023). Two hundred patients with axSpA meeting ASAS classification criteria (1 30 males, 70 females) receiving continuous anti-TNF therapy were evaluated. Clinical measures including Erythrocyte Sedimentation Rate (ESR), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and Bath Ankylosing Spondylitis Functional Index (BASFI) were assessed at baseline, 3 months, and 6 months post-treatment. Results: Male patients demonstrated significantly higher rates of radiographic disease (76.9% vs. 37.1 %, p < 0.001), HLA-B27 positivity (36.9% vs. 1 8.6%, p = 0.007), and smoking history (63.1 % vs. 7.1 %, p < 0.001). Conversely, females presented with higher rates of non-radiographic axSpA (62.9%), obesity (40.0% vs. 33.1 %, p = 0.04), and concomitant csDMARD use (38.6% vs. 9.2%, p < 0.001). Both sexes exhibited significant clinical improvement from baseline to 6 months (p < 0.001). However, female sex was associated with persistently higher residual disease activity (BASDAI at 6 months: 3.1 ± 1 .4 vs. 2.4 ± 1 .1 4, p = 0.001), worse functional capacity (BASFI at 6 months: 3.3 ± 1 .3 vs. 2.7 ± 1 .4, p = 0.01), and elevated inflammatory markers (ESR at 6 months: 21 .9 ± 1 5.8 vs. 1 4.2 ± 11 .8 mm/h, p < 0.001). Conclusions: Although TNF inhibitors are clinically effective in both sexes, Iraqi female axSpA patients present with higher baseline disease burden, greater functional impairment, and attenuated therapeutic response over 6 months compared to males.

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