{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T13:04:45Z","timestamp":1784120685357,"version":"3.55.0"},"reference-count":50,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"content-version":"unspecified","delay-in-days":14,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100031478","name":"NextGenerationEU","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100031478","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"accepted":{"date-parts":[[2026,7,2]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A longitudinal observational study was conducted in 411 patients with SpA from the Spanish REGISPONSER registry (baseline 2004\u20132007), who were reassessed 17 years later in REGISPON-3 (2021\u20132024). Outcomes were Bath Ankylosing Spondylitis Functional Index (BASFI) at follow-up, \u0394BASFI 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 \u0394BASFI, with sex as a moderator.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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 (\u0394BASFI 1.47\u00b12.81 vs 0.38\u00b12.57, p&lt;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 \u0394BASFI 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 \u0394BASFI through CRP was significant in male patients but not in female patients with a significant sex interaction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rmdopen-2026-007008","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T12:10:46Z","timestamp":1784117446000},"page":"e007008","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Sex differences in long-term functional deterioration and permanent disability in spondyloarthritis: a 17-year follow-up from the REGISPON-3 study"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7746-7942","authenticated-orcid":false,"given":"Diana Maria Margareta","family":"Moldovan","sequence":"first","affiliation":[{"name":"2nd Internal Medicine Department, Iuliu Ha\u021bieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania"},{"name":"Medical and Surgical Sciences Department, University of Cordoba, 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Ena","family":"Granados","sequence":"additional","affiliation":[{"name":"Medical and Surgical Sciences Department, University of Cordoba, C\u00f3rdoba, Spain"},{"name":"Maimonides Biomedical Research Institute of Cordoba (IMIBIC), C\u00f3rdoba, Spain"},{"name":"Rheumatology Department, Reina Sofia University Hospital, C\u00f3rdoba, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos M","family":"Collantes-S\u00e1nchez","sequence":"additional","affiliation":[{"name":"Medical and Surgical Sciences Department, University of Cordoba, C\u00f3rdoba, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandro","family":"Escudero-Contreras","sequence":"additional","affiliation":[{"name":"Medical and Surgical Sciences Department, University of Cordoba, C\u00f3rdoba, Spain"},{"name":"Maimonides Biomedical Research Institute of Cordoba (IMIBIC), C\u00f3rdoba, Spain"},{"name":"Rheumatology Department, Reina Sofia University Hospital, C\u00f3rdoba, 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