Impact of sex and HLA-B27 positivity on clinical characteristics and patient-reported outcomes in a cohort of Egyptian axial spondyloarthritis patients

Abstract

To assess the clinical characteristics, disease activity, functional status, and quality of life of Egyptian patients with axial spondyloarthritis (axSpA), and to evaluate differences according to sex and HLA-B27 status. This cross-sectional study included 256 patients fulfilling the Assessment of SpondyloArthritis international Society (ASAS) classification criteria for axSpA. Clinical, laboratory, imaging, and treatment data were collected. Disease activity was assessed using ASDAS-CRP and BASDAI, functional status using BASFI, spinal mobility using BASMI, and quality of life using ASQoL. Comparisons were performed according to sex, HLA-B27 status, and combined sex/HLA-B27 subgroups. Of 256 patients, 57.4% were male, 55.9% were HLA-B27 positive, and 70.3% had radiographic axSpA. Female patients demonstrated higher disease activity, greater functional impairment, and poorer quality of life, as reflected by higher BASDAI, BASFI, and ASQoL scores. HLA-B27-positive patients more commonly exhibited axial-dominant disease, whereas HLA-B27-negative patients showed higher frequencies of peripheral involvement, enthesitis, and dactylitis. Combined stratification by sex and HLA-B27 status demonstrated that female HLA-B27-negative patients had the highest disease activity, functional impairment, and quality-of-life impairment among all subgroups. Disease expression and patient-reported outcomes in axSpA differ according to both sex and HLA-B27 status. Despite geographic and healthcare-system differences, the observed patterns were broadly consistent with those reported in international cohorts. The combined evaluation of sex and HLA-B27 status may provide additional insight into disease heterogeneity and patient burden in axSpA.