{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T17:16:54Z","timestamp":1791911814864,"version":"4.3.4"},"reference-count":48,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2023,7,28]],"date-time":"2023-07-28T00:00:00Z","timestamp":1690502400000},"content-version":"unspecified","delay-in-days":27,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Swiss Ankylosing Spondylitis Foundation, Zurich, Switzerland"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"accepted":{"date-parts":[[2023,7,10]]},"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To investigate sex differences in spinal radiographic progression in axial spondyloarthritis (axSpA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>AxSpA patients in the Swiss Clinical Quality Management cohort with available spinal radiographs every 2 years were included. Paired radiographs were scored by two readers according to the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). Progression was defined as an increase of \u22652 mSASSS units in 2 years. The relationship between sex and progression was investigated with binomial generalised estimating equation models, considering baseline spinal damage as an intermediate covariate. Additional analyses included adjustments for explanatory variables and multiple imputations for missingness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In a total of 505 axSpA patients (317 men and 188 women), mean\u00b1SD radiographic progression over 2 years was 1.0\u00b12.8 years in men and 0.3\u00b11.1 years in women (p&lt;0.001). Male sex was associated with enhanced progression in a small model not including baseline damage (OR 3.41, 95% CI 1.87 to 6.21). Both a direct effect of male sex on spinal progression, and an indirect effect, via enhancement of baseline spinal damage were significant (OR 2.06, 95% CI 1.15 to 3.67 and OR 1.04, 95% CI 1.01 to 1.07, respectively). A significant impact of male sex on spinal radiographic progression was still demonstrated after multiple adjustments for covariates known to potentially affect spinal radiographic progression (OR 1.97, 95% CI 1.04 to 3.71).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Spinal radiographic progression in axSpA is more severe in men than in women, with three times higher odds of progression in male patients and an effect that is mediated in part through an increase in baseline radiographic damage.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rmdopen-2023-003340","type":"journal-article","created":{"date-parts":[[2023,7,28]],"date-time":"2023-07-28T13:01:13Z","timestamp":1690549273000},"page":"e003340","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Impact of sex on spinal radiographic progression in axial spondyloarthritis: a longitudinal Swiss cohort analysis over a period of 10 years"],"prefix":"10.1136","volume":"9","author":[{"given":"Caroline","family":"Ensslin","sequence":"first","affiliation":[{"name":"Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8918-7304","authenticated-orcid":false,"given":"Raphael","family":"Micheroli","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seraphina","family":"Kissling","sequence":"additional","affiliation":[{"name":"Statistics Group, Swiss Clinical Quality Management in Rheumatic Diseases, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"G\u00f6tschi","sequence":"additional","affiliation":[{"name":"Statistics Group, Swiss Clinical Quality Management in Rheumatic Diseases, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristina","family":"B\u00fcrki","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ren\u00e9","family":"Br\u00e4m","sequence":"additional","affiliation":[{"name":"Swiss Ankylosing Spondylitis Association, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0652-9808","authenticated-orcid":false,"given":"Manouk","family":"de Hooge","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, University Hospital Gent, Gent, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9475-9362","authenticated-orcid":false,"given":"Xenofon","family":"Baraliakos","sequence":"additional","affiliation":[{"name":"Rheumazentrum Ruhrgebiet, Ruhr University Bochum, Herne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6326-1764","authenticated-orcid":false,"given":"Michael J","family":"Nissen","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Geneva University Hospitals, Geneve, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Burkhard","family":"M\u00f6ller","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, Inselspital Universitatsspital Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pascale","family":"Exer","sequence":"additional","affiliation":[{"name":"Praxis Rheuma-Basel, 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