Impact of Sex and HLA-B27 Positivity on Clinical Characteristics and Patient-Reported Outcomes in a Cohort of Egyptian Axial Spondyloarthritis Patients

Impact of Sex and HLA-B27 Positivity on Clinical Characteristics and Patient-Reported Outcomes in a Cohort of Egyptian Axial Spondyloarthritis Patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of Sex and HLA-B27 Positivity on Clinical Characteristics and Patient-Reported Outcomes in a Cohort of Egyptian Axial Spondyloarthritis Patients Eiman Soliman, Magdy Zeheiry, Yasmine Abu Halawa, Ahmed Shaaban This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9448653/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Objective: To assess the clinical features, disease activity, functional status, and quality of life in Egyptian patients with axial spondyloarthritis (axSpA), and to explore the influence of gender and HLA-B27 status on disease expression. Methods: This cross-sectional study included 256 patients fulfilling ASAS criteria for axSpA. Clinical data, HLA-B27 status, laboratory markers, imaging findings, and treatment regimens were recorded. Disease activity was measured using ASDAS-CRP and BASDAI, functional status with BASFI, spinal mobility with BASMI, and quality of life with ASQoL. Statistical analyses were performed to assess gender and HLA-B27-related differences. Results: Of 256 patients (57.4% male), 55.9% were HLA-B27 positive and 70.3% had radiographic axSpA. The cohort demonstrated very high disease activity (mean ASDAS-CRP 4.57 ± 0.91), exceeding values reported in most international studies. Females showed more peripheral joint involvement and dactylitis, with higher BASDAI, BASFI, and ASQoL scores, indicating greater disease burden. HLA-B27 positive patients were more likely to have axial disease and elevated CRP levels, while HLA-B27 negative patients had higher rates of peripheral involvement, enthesitis, and dactylitis. HLA-B27 positivity was associated with better quality of life. Conclusion: AxSpA shows marked variability influenced by gender and HLA-B27 status. Female patients experience more severe symptoms and functional limitations, warranting tailored, gender-sensitive care. HLA-B27 positivity correlates with axial involvement and more favorable outcomes, underscoring its clinical relevance. Comprehensive, individualized treatment approaches are essential to address both physical and psychosocial aspects of the disease. Figures Figure 1 Figure 2 Figure 3 Background Axial spondyloarthritis (axSpA) encompasses a heterogeneous group of inflammatory disorders primarily affecting the axial skeleton, distinguished by unique genetic, pathogenic, and clinical characteristics that differentiate them from other inflammatory arthritides. A hallmark feature of axSpA is chronic lower back pain, which typically manifests before the age of 45.[ 1 ] This pain is of inflammatory origin and is frequently accompanied by other musculoskeletal manifestations, including enthesitis, peripheral arthritis, and, less commonly, dactylitis.[ 2 ] Furthermore, axSpA is frequently associated with extra-articular manifestations (EAMs), such as uveitis, psoriasis, and inflammatory bowel disease (IBD).[ 3 ] Genetic predisposition plays a critical role in axSpA, with the Human leukocyte antigen B27 (HLA-B27) demonstrating the strongest association with disease susceptibility. The presence of HLA-B27 increases the likelihood of developing axSpA by approximately 1.5 times compared to HLA-B27-negative individuals. [ 4 , 5 ] Beyond genetic susceptibility, multiple factors contribute to the pathogenesis and progression of axSpA. Proinflammatory cytokines, particularly tumor necrosis factor-alpha (TNF-α) and interleukin-17 (IL-17), play a central role in sustaining inflammation and driving both pain and tissue damage.[ 6 ] Additionally, emerging evidence suggests a connection between gut microbiota alterations and axSpA. These complex interactions not only shape disease expression but also influence treatment strategies and long-term outcomes.[ 7 ] Health-related quality of life (HRQoL) in axSpA is significantly affected due to the disease burden and its treatment.[ 8 ] Patients frequently report chronic pain, progressive impairment of spinal mobility, fatigue even with minimal exertion, sleep disturbances, and psychological comorbidities such as depression, all of which contribute to a substantial reduction in overall well-being. [ 9 ] This study aimed to assess the clinical characteristics, disease activity, functional status, treatment patterns, and HRQoL in a cohort of Egyptian patients with axSpA. Furthermore, we explored the associations between clinical characteristics and HLA-B27 status, along with differences in clinical presentation based on gender. Subjects and Methods This study employed a cross-sectional observational design conducted over a 12-month period in the Rheumatology Unit, Alexandria University Hospital. 256 Egyptian patients fulfilling the Assessment of SpondyloArthritis International Society (ASAS) classification criteria were recruited. Patients with comorbid IBD and psoriatic arthritis (PsA) were excluded from the study. This study was approved by the Ethical Committee of the Faculty of Medicine, Alexandria University. Prior to baseline examination, each patient was to be interrogated thoroughly about symptoms, onset, course and duration of the disease, co-morbid illness, extra articular manifestations, and family history. HLA-B27 status was determined from patient medical records. Patients were asked to fill in the ASQoL questionnaire [ 8 ]. The questionnaire includes items related to the impact of disease on sleep, mood, motivation, coping, activities of daily living, independence, relationships, and social life. Scoring is in dichotomous responses, with 0 scored for a “no” and 1 scored for a “yes” for each item. Total score is the sum of the individual responses. Score range is 0–18, with higher scores reflecting greater impairment of HrQoL. Laboratory investigations included a complete blood picture (CBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), serum creatinine, aspartate aminotransferase (AST) and alanine transaminase (ALT) as well as HLA-B27 testing. Imaging choices in this study were primarily determined by availability and cost, with most patients proceeding directly to (MRI) of the sacroiliac (SI) joints, while a smaller proportion underwent plain radiography (X-Ray). MRI utilization was mainly influenced by insurance authorization policies and the requirement of MRI confirmation for medication approval. Sacroiliitis was considered positive if X-rays showed at least grade 2 bilaterally or grade 3 unilaterally, according to the modified New York criteria [ 10 ], or if MRI findings fulfilled the ASAS definition for active sacroiliitis, which requires the presence of bone marrow edema (BME) in typical subchondral locations on at least two consecutive slices or multiple lesions on a single slice, consistent with inflammatory activity .[ 11 ] Disease activity was evaluated using Ankylosing Spondylitis Disease Activity Score using C-reactive protein (ASDAS-CRP) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Functional impairment was assessed through the Bath Ankylosing Spondylitis Functional Index (BASFI) and spinal mobility was assessed using the Bath Ankylosing Spondylitis Metrology Index (BASMI). Patient-reported outcomes were obtained using the ASQoL questionnaire. [ 12 ] Gender and HLA-B27 status were the primary variables of interest, and their relationship with disease activity, functional impairment, spinal mobility, and patient-reported outcomes were analyzed. Data were entered and analyzed using IBM SPSS Statistics software version 20.0 (Armonk, NY: IBM Corp). Qualitative variables were summarized as frequencies and percentages, while the normality of quantitative data distribution was assessed using the Kolmogorov-Smirnov test. Quantitative variables were presented as range (minimum and maximum), mean, standard deviation, median, and interquartile range (IQR). A significance level of 5% was used to determine statistical significance. Results This study included 256 patients, comprising 147 males (57.4%) and 109 females (42.6%). HLA-B27 positivity was observed in 143 patients (55.9%), while 113 patients (44.1%) were HLA-B27 negative. Of the total cohort, 76 patients (29.7%) were classified as nr-axSpA, whereas 180 patients (70.3%) were classified as r-axSpA. Table 1 presents the sociodemographic, clinical, and disease-specific measures of the study population. The mean BASDAI and BASFI scores for the total cohort were 6.12 ± 1.74 and 6.05 ± 2.03, respectively, reflecting a high disease burden overall. When analyzed by gender, female patients exhibited significantly higher disease activity and functional impairment (median BASDAI = 7.03 [IQR 6.18–7.90] vs. 6.20 [IQR 5.0–6.80], p = 0.049 ; median BASFI = 7.0 [IQR 5.90–7.90] vs. 6.50 [IQR 5.0–7.90], p < 0.001 ) and a lower quality of life (ASQoL = 14.0 [IQR 10.0–16.0] vs. 12.0 [IQR 9.0–16.0], p < 0.001 ) compared to males. In contrast, male patients were more likely to exhibit axial-only involvement (33.0% vs. 16.3%, p = 0.047 ), while females had higher rates of combined axial and peripheral joint involvement and more frequent dactylitis (22.4% vs. 7.4%, p = 0.018 ). The occurrence of uveitis and enthesitis did not differ significantly between genders ( p > 0.05 ). These findings are detailed in Table 2 (Gender-Stratified Analysis of HLA-B27 Positive and Negative Patients) and illustrated in Fig. 1 , which depicts the correlation between gender and disease activity, functional limitation, spinal mobility, and quality of life. Male patients were more likely to have axial-only involvement, whereas females commonly exhibited both axial and peripheral joint involvement. Females also showed higher rates of dactylitis, although the incidence of enthesitis did not differ significantly between sexes. Uveitis occurrence was similar between males and females. (Table 2) Additionally, females reported higher disease activity (BASDAI), functional impairment (BASFI), and poorer quality of life (ASQoL). (Fig. 1 ) Figure (1): Gender and Disease Activity, Spinal Mobility, Functional Limitation and Quality of Life. HLA-B27 positive patients exhibited a greater tendency for axial involvement, while HLA-B27 negative individuals demonstrated higher rates of both axial and peripheral joint involvement. Enthesitis was more commonly observed in HLA-B27 negative patients, while dactylitis was also more prevalent among this group. Although uveitis was slightly more frequent in HLA-B27 positive patients, this difference did not reach statistical significance (Table 3). HLA-B27 positive patients exhibited higher CRP levels, whereas HLA-B27 negative individuals demonstrated greater disease activity (BASDAI), more pronounced functional impairment (BASFI), and poorer quality of life (ASQoL) (Figs. 2–3). Figure (2): HLA-B27 and Disease Activity, Spinal Mobility, Functional Limitation and Quality of Life. Figure (3) Correlation between ASQoL and ASDAS-CRP Discussion Axial SpA is a heterogeneous inflammatory disorder primarily affecting the axial skeleton, with chronic lower back pain as a hallmark feature and frequent musculoskeletal and extra-articular manifestations such as enthesitis, uveitis, and IBD. Genetic predisposition, particularly the strong association with HLA-B27, alongside proinflammatory cytokines like TNF-α and IL-17, play key roles in disease pathogenesis, with emerging evidence suggesting gut microbiota involvement. The chronic inflammation and disease burden significantly impact HRQoL, contributing to pain, spinal mobility impairment, fatigue, sleep disturbances, and psychological comorbidities. Our study found that 55.9% of axSpA patients were HLA-B27 positive, aligning with Tayel et al.[ 13 ] at 58.7% and Poddubny et al.[ 14 ] at 57.6%. However, according to Poddubny et al.[ 14 ], HLA-B27 prevalence varies significantly by region, with Europe showing the highest positivity (80.3%) and Canada the lowest (29.4%). This emphasizes the need for geographically diverse registries to better understand axSpA genetics. Additionally, HLA-B27 positivity was significantly higher in males (63.9%) than females (45.0%) (p = 0.002), consistent with findings from Blasco-Blasco et al.[ 15 ] These gender differences suggest that genetic factors influence disease susceptibility, clinical presentation, and progression, potentially affecting arthritis patterns and associated symptoms. This analysis unveiled intriguing patterns in the relationship between HLA-B27 and arthritis manifestations, revealing that HLA-B27 negative patients exhibited a higher prevalence of both axial and peripheral arthritis, with 83.2% of these individuals presenting dual manifestations compared to 72.7% of HLA-B27 positive patients (p = 0.047). This observation resonates with Zhang et al.’s [ 16 ] findings, which indicated elevated rates of peripheral arthritis among HLA-B27 negative patients (36.2% vs. 27.0%, p = 0.001), highlighting a nuanced interplay between HLA-B27 negativity and the broader spectrum of arthritis. Complementing these insights, this work also uncovered marked gender disparities in arthritis patterns. Males reported significantly higher incidences of low back pain (30.6%) compared to females (11.9%) (p < 0.001), while peripheral arthritis was more prevalent among females (88.1%) than males (69.4%). These observations are in line with Almousa et al.'s [ 17 ] research, which documented a higher prevalence of peripheral arthritis in females (38.8% vs. 14.5%, p = 0.007) and greater rates of low back pain in males (69.7% vs. 23.7%, p < 0.001). Our analysis further revealed that HLA-B27 positive patients exhibited a lower prevalence of enthesitis compared to their HLA-B27 negative counterparts (53.1% vs. 68.1%, p = 0.015). This trend is consistent with Zhang et al.’s [ 16 ] report, which also noted a lower prevalence among HLA-B27 positive patients, though the difference was not statistically significant (64.6% vs. 68.1%, p = 0.146). The study also unveiled a notable trend towards a higher prevalence of enthesitis among females (66.1%) in comparison to males (55.1%), although this difference did not reach statistical significance (p = 0.077). Blasco-Blasco et al.’s [15)] meta-analysis, utilizing the Maastricht Ankylosing Spondylitis Enthesitis Score (MASES), also revealed slightly higher scores for females (2.5) compared to males (1.7), although this discrepancy was not statistically significant (p = 0.23). It should be noted that clinically evaluating enthesitis presents significant challenges due to its multifaceted nature, which can stem from mechanical injury or conditions like fibromyalgia. Some entheses are notably difficult to assess, and the absence of localized pain does not definitively rule out the presence of enthesitis. Reported prevalence rates may not truly capture the condition's full extent, implying that the actual incidence might be higher than currently recognized. Considering uveitis, the present study observed that uveitis was present in 22.9% of females and 17.7% of males, with no statistically significant gender difference (p = 0.299). This finding diverges from the meta-analysis by Blasco-Blasco et al.[ 15 ], which reported a higher frequency of uveitis in males, aligning with other studies suggesting a male predominance. The observed discrepancy may be attributable to the presence of a multidisciplinary uveitis clinic within our study setting, which may have introduced a bias in our findings. This factor could account for the divergence from the male predominance in uveitis reported in other studies. To gain a deeper understanding of disease severity and inflammation in axSpA, it is crucial to examine how gender and HLA-B27 may influence key markers such as CRP and disease activity indices. By investigating these relationships, we can better interpret how systemic inflammation and disease activity differ between genders and HLA-B27. This exploration will provide a more comprehensive view of how these factors contribute to the overall disease burden and inform more tailored approaches to treatment and management in axSpA. Although both gender and HLA-B27 status affect CRP levels, these factors do not seem to impact ASDAS-CRP scores. Benavent et al. [ 18 ] reported that gender had no significant effect on ASDAS-CRP, showing minimal gender-related variation in ASDAS-CRP scores within their cohort. consistent with these findings, our study similarly reports no significant gender-based differences in ASDAS-CRP scores, with mean values of 4.53 for males and 4.60 for females (p = 0.823). Both investigations therefore converge on the conclusion that gender does not substantially affect ASDAS in axSpA. However, significant gender disparities were observed in BASDAI scores, with women consistently reporting higher scores than men across both our study and Tournadre et al.’s[ 19 ] studies. This suggests that while objective measures like ASDAS-CRP may reflect comparable disease activity between genders, subjective assessments such as BASDAI highlight a perceived higher disease burden among women with axSpA. In regard to HLA-B27 however, Arévalo et al. [ 20 ] documented a significant increase in ASDAS-CRP scores for HLA-B27 positive patients (mean = 1.96) compared to HLA-B27 negative individuals (mean = 2.09), with a p-value of 0.002, highlighting a pronounced link between HLA-B27 positivity and elevated disease activity. Conversely, our analysis found no significant difference in ASDAS-CRP scores between HLA-B27 positive (mean = 4.53) and HLA-B27 negative patients (mean = 4.60), with a p-value of 0.638. This suggests that, within our cohort, HLA-B27 status does not significantly affect disease activity as assessed by ASDAS-CRP. The mean ASDAS-CRP in this cohort was notably high (4.57 ± 0.91), reflecting very high disease activity across the study population. This value exceeds those reported in several international cohorts, where mean ASDAS-CRP values typically range between 2.5 and 3.5. Several factors may explain this difference. First, patients in our cohort had a prolonged diagnostic delay (mean 8.5 years), which likely contributed to accumulated disease burden and functional impairment at presentation. Second, the study population was recruited from a tertiary referral center, where patients tend to have more severe or treatment-resistant disease. Third, limited access to early biologic therapy and variations in healthcare coverage may have delayed optimal treatment initiation. Finally, genetic and environmental influences unique to the regional population could also contribute to heightened inflammatory activity. The discrepancy between our findings and those of Arévalo et al. [ 20 ], who reported significantly higher ASDAS-CRP values among HLA-B27–positive patients, may partly reflect differences in overall disease activity between cohorts. In our study, the mean ASDAS-CRP was substantially higher (4.57 ± 0.91) compared with approximately 2.0 in the Arévalo et al. cohort. This markedly elevated baseline activity could have attenuated or masked potential differences between HLA-B27 subgroups, as inflammatory burden was uniformly high across the study population. Moreover, cohort differences in disease duration, referral patterns, and treatment exposure may have further contributed to the divergent findings. Health related quality of life assessments in axSpA are critical for understanding the comprehensive impact of the disease on patients. In comparing quality of life, our study and findings from Mease et al.[ 21 ], significant differences emerge, particularly regarding gender disparities. Our work reveals higher ASQoL scores among females, indicating poorer health-related quality of life compared to males. Mease et al.'s [ 21 ] broader assessment corroborates these findings, showing that females consistently report higher levels of pain, fatigue, and disability, along with lower overall health scores compared to males. These findings highlight the persistent gender-based disparities in axSpA, highlighting the importance of tailored interventions that address these specific quality of life challenges faced by female patients. The results also indicated that HLA-B27 positive patients had significantly lower ASQoL scores (mean 10.18) compared to HLA-B27 negative patients (mean 12.66), with a p-value of less than 0.001. Lower ASQoL scores indicate better HRQoL, suggesting that HLA-B27 positive patients in our study report a better quality of life. This may be explained by the presence of less dactylitis and peripheral arthritis in HLA-B27 positive patients, as compared to HLA-B27 negative patients. In Carvalho et al.'s [ 9 ] SpA study, they explored how ASDAS-CRP impacts HRQoL assessed by EQ-5D-3L (EuroQol 5-Dimensional 3-Level). Their research highlighted a notable inverse relationship: higher ASDAS-CRP scores were significantly associated with lower HRQoL (adjusted B = -0.052, p < 0.001), highlighting the detrimental effect of increased disease activity on quality of life. Similarly, in our investigation, we observed a meaningful positive correlation between ASQoL and ASDAS-CRP (rs = 0.277, p < 0.001). This suggests that heightened disease activity aligns with diminished quality of life scores, reinforcing the critical impact of disease management on patient well-being. Both our work and Sallam et al.'s [ 23 ] study consistently demonstrate a significant correlation between higher BASDAI scores and poorer quality of life outcomes in patients with axSpA. In our study, the correlation coefficient was 0.650 (p < 0.001), while Sallam et al.'s [ 23 ] study reported a regression coefficient of 1.08 (p = 0.02), emphasizing the negative impact of increased disease activity on patient well-being. These findings highlight the critical need for effective disease management to enhance quality of life. Conclusion Axial spondyloarthritis (axSpA) demonstrates considerable clinical heterogeneity influenced by demographic factors, genetic predisposition—particularly HLA-B27 status—and diverse disease manifestations, underscoring the need for individualized diagnostic and management strategies. Gender differences are evident, with women often exhibiting a higher overall disease burden and more frequent peripheral involvement, including dactylitis. These findings highlight the importance of gender-sensitive care, including a lower threshold for investigating peripheral joint symptoms in women to prevent underdiagnosis and delayed treatment. HLA-B27 positivity appears to modulate disease expression, being associated with better quality of life and lower frequencies of enthesitis, peripheral arthritis, and dactylitis. Given the profound impact of axSpA on functional capacity and quality of life, comprehensive, holistic management—addressing not only inflammation and pain but also sleep disturbances, fatigue, fibromyalgia, and psychosocial well-being—is essential to optimize long-term outcomes. Abbreviations • AxSpA Axial spondyloarthritis • HLA-B27 Human leukocyte antigen B27 • ASDAS-CRP Ankylosing Spondylitis Disease Activity Score using C-reactive protein • BASDAI Bath Ankylosing Spondylitis Disease Activity Index • BASMI Bath Ankylosing Spondylitis Metrology Index • BASFI Bath Ankylosing Spondylitis Functional Index • ASQoL Ankylosing Spondylitis Quality of Life • EAM Extra-articular manifestations • IBD Inflammatory bowel disease • TNF Tumor necrosis factor • IL Interleukin • ASAS Assessment of SpondyloArthritis International Society • PsA Psoriatic arthritis • CBC Complete blood count • ESR Erythrocyte sedimentation rate • CRP C-reactive protein • AST Aspartate aminotransferase • ALT Alanine aminotransferase • SI Sacroiliac • MRI Magnetic resonance imaging • X-Ray Plain Radiography • BME Bone marrow edema Declarations Clinical trial number not applicable. Ethics approval and consent to participate The study was approved by the Ethics Committee of the Faculty of Medicine, Alexandria University (Approval No. 0107729). Written informed consent was obtained from all participants prior to their inclusion in the study. All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Author Contribution Eiman Soliman, Yasmine Abu Halawa, Magdy Zeheiry, and Ahmed Shaaban all contributed equally to the study’s conception, design, data collection, analysis, interpretation, and manuscript preparation. All authors read and approved the final version of the manuscript Acknowledgement The authors would like to thank the staff of the Rheumatology and Clinical Immunology Division, Alexandria University, for their support and assistance throughout the study. Data Availability The datasets generated and/or analyzed during the current study are not publicly available due to institutional regulations and patient confidentialitybut are available from the corresponding author on reasonable request. References Sieper J, Rudwaleit M, Baraliakos X, Brandt J, Burgos-Vargas R, Dougados M, et al. The Assessment of Spondyloarthritis International Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis. 2009;68:1–44. https://doi.org/10.1136/ard.2008.104018 . Yu DT, van Tubergen A. Overview of the clinical manifestations and classification of spondyloarthritis. In: Connor RF, editor. UpToDate. Wolters Kluwer; [cited 2024 Apr 14]. El Maghraoui A. Extra-articular manifestations of ankylosing spondylitis: prevalence, characteristics, and therapeutic implications. Eur J Intern Med. 2011;22(6):554–60. https://doi.org/10.1016/j.ejim.2011.06.006 . Yu DT, van Tubergen A. Pathogenesis of spondyloarthritis. In: Connor RF, editor. UpToDate. Wolters Kluwer; [cited 2023 Mar 28]. Lin H, Gong YZ. Association of HLA-B27 with ankylosing spondylitis and clinical features of the HLA-B27-associated ankylosing spondylitis: a meta-analysis. Rheumatol Int. 2017;37(8):1267–80. https://doi.org/10.1007/s00296-017-3741-2 . Ceribelli A, Motta F, Vecellio M, Isailovic N, Ciccia F, Selmi C. Clinical trials supporting the role of the IL-17/IL-23 axis in axial spondyloarthritis. Front Immunol. 2021;12:622770. https://doi.org/10.3389/fimmu.2021.622770 . Jacques P, van Praet L, Carron P, Van den Bosch F, Elewaut D. Pathophysiology and role of the gastrointestinal system in spondyloarthritides. Rheum Dis Clin North Am. 2012;38(3):569–82. https://doi.org/10.1016/j.rdc.2012.08.012 . Doward LC, Spoorenberg A, Cook SA, Whalley D, Helliwell PS, Kay LJ et al. Development of the ASQoL: a quality of life instrument specific to ankylosing spondylitis. Ann Rheum Dis [cited 2023 Jun 2]. https://doi.org/10.1136/ard.62.1.20 Kiltz U, Braun J. Assessments of functioning in patients with axial spondyloarthritis. J Rheum Dis. 2020;27(1):22–9. https://doi.org/10.4078/jrd.2020.27.1.22 . Van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. Arthritis Rheum. 1984;27(4):361–8. https://doi.org/10.1002/art.1780270401 . Lambert RGW, Bakker PAC, Van Der Heijde D, Weber U, Rudwaleit M, Hermann KGA, et al. Defining active sacroiliitis on MRI for classification of axial spondyloarthritis: update by the ASAS MRI working group. Ann Rheum Dis. 2016;75(11):1958–63. https://doi.org/10.1136/annrheumdis-2015-208642 . Zochling J. Measures of symptoms and disease status in ankylosing spondylitis: Ankylosing Spondylitis Disease Activity Score (ASDAS), Ankylosing Spondylitis Quality of Life Scale (ASQoL), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Global Score (BAS-G), Bath Ankylosing Spondylitis Metrology Index (BASMI), Dougados Functional Index (DFI), and Health Assessment Questionnaire for the Spondylarthropathies (HAQ-S). Arthritis Care Res (Hoboken). 2011;63(S11):S47–58. https://doi.org/10.1002/acr.20575 . Tayel MY, Soliman E, El Baz WF, El Labaan A, Hamaad Y, Ahmed MH. Registry of the clinical characteristics of spondyloarthritis in a cohort of Egyptian population. Rheumatol Int. 2012;32:2837–42. https://doi.org/10.1007/s00296-011-2068-7 . Poddubnyy D, Sieper J, Akar S, Muñoz-Fernández S, Haibel H, Hojnik M, et al. Characteristics of patients with axial spondyloarthritis by geographic regions: PROOF multicountry observational study baseline results. Rheumatology. 2022;61(8):3299–308. https://doi.org/10.1093/rheumatology/keab901 . Blasco-Blasco M, Castrejón I, Jovaní V, Pascual E, Ruiz-Cantero MT. Reviewing disease activity indices in spondyloarthritis from the sex perspective: a systematic review and meta-analysis. J Rheumatol. 2021;48(9):1395–404. https://doi.org/10.3899/jrheum.200967 . Zhang S, Wang Y, Peng L, Su J, Zeng X, Li M, et al. Comparison of clinical features in HLA-B27 positive and negative patients with axial spondyloarthritis: results from a cohort of 4,131 patients. Front Med (Lausanne). 2020;7:609562. https://doi.org/10.3389/fmed.2020.609562 . Almousa S, Alshamaa N, Wannous H, Khder K, Qasem H. Gender-related differences in axial spondyloarthritis (axSpA) patients. Egypt Rheumatologist. 2023;45(1):13–6. https://doi.org/10.1016/j.ejr.2022.08.003 . Benavent D, Capelusnik D, Ramiro S, Molto A, López-Medina C, Dougados M, et al. Does gender influence outcome measures similarly in patients with spondyloarthritis? Results from the ASAS-perSpA study. RMD Open. 2022;8(2):e002514. https://doi.org/10.1136/rmdopen-2022-002514 . Tournadre A, Pereira B, Lhoste A, Dubost JJ, Ristori JM, Claudepierre P, et al. Differences between women and men with recent-onset axial spondyloarthritis: results from a prospective multicenter French cohort. Arthritis Care Res (Hoboken). 2013;65(9):1482–9. https://doi.org/10.1002/acr.22001 . Arévalo M, López-Medina C, Moreno Martinez-Losa M, Moltó A, Font P, Collantes-Estevez E, et al. Role of HLA-B27 in the comorbidities observed in axial spondyloarthritis: data from COMOSPA. Joint Bone Spine. 2020;87(5):445–8. https://doi.org/10.1016/j.jbspin.2020.03.012 . Mease PJ, McLean RR, Dube B, Liu M, Rebello S, Glynn M, et al. Comparison of men and women with axial spondyloarthritis in the US-based Corrona Psoriatic Arthritis/Spondyloarthritis Registry. J Rheumatol. 2021;48(10):1528–36. https://doi.org/10.3899/jrheum.201549 . Carvalho PD, Vieira-Sousa E, Hmamouchi I, Marreiros A, Machado PM. Determinants of health-related quality of life in spondyloarthritis and rheumatoid arthritis - data from the COMOSPA and COMORA studies. Semin Arthritis Rheum. 2022;57:152086. https://doi.org/10.1016/j.semarthrit.2022.152086 . Sallam RA, Elbahnasawy AS. Health-related quality of life (HRQoL) in ankylosing spondylitis patients: relation to clinical features, disease activity, and radiographic damage. Egypt Rheumatologist. 2020;42(4):287–90. https://doi.org/10.1016/j.ejr.2020.02.006 . Tables Table (1) Sociodemographic, clinical, and disease specific measures in patients with axSpA. Demographic data No. % Gender Male 147 57.4 Female 109 42.6 Age (years) Min. – Max. 17.0 – 70.0 22.7 Mean ± SD. 38.85 ± 9.96 77.3 Median (IQR) 38.50 (32.0 – 45.0) 59.8 Mean ± SD. Min–Max Age of disease onset (years) 26.37 ± 7.62 15.0 – 50.0 Age at diagnosis (years) 34.85 ± 9.34 16.0 – 60.0 Diagnosis Gap (years) 8.48 ± 7.02 0.0 – 28.0 Smoking Non-Smoker 172 67.18 Smoker 62 24.2 Ex-Smoker 22 8.6 Family history No 200 78.1 Yes 56 21.9 Medications No. % Biologics 180 70.3 Secukinumab 63 24.6 Adalimumab Biosimilar 42 16.4 Adalimumab 30 11.7 Golimumab 27 10.5 Etanercept 18 7.0 Non-Biological Treatment 76 29.7 NSAIDs 73 28.5 cDMARDs alone 3 1.2 Min. – Max Mean ± SD. CRP 12.81 ± 13.84 0.20 – 68.0 ASDAS-CRP 4.56 ± 0.91 1.75 – 6.45 BASDAI 6.12 ± 1.74 1.40 – 9.75 BASFI 6.05 ± 2.03 1.50 – 10.0 BASMI 4.48 ± 2.70 0.0 – 10.0 ASQol 11.28 ± 4.75 0.0 – 18.0 Table (2): Gender-Stratified Analysis of HLA-B27 Positive and Negative Patients Parameter Total positive (n = 143) HLA-B27 Positive Total Negative (n = 113) HLA-B27 Negative Test of Sig p-value. p 0 HLA-B27 Positive VS negative Males (n= 94) G1 Females (n= 49) G2 Males (n= 53) G3 Females (n= 60) G4 Pattern of joint involvement - Axial only, n (%) 39 (27.3%) 31 (33.0%) 8 (16.3%) 19 (16.8%) 14 (26.4%) 5 (8.3%) χ²=14.28 * p = 0.003 * χ²=3.940 * p = 0.047 * - Axial + Peripheral, n (%) 104 (72.7%) 63 (67.0%) 41 (83.7%) 94 (83.2%) 39 (73.6%) 55 (91.7%) Enthesitis, n (%) 76 (53.1%) 44 (46.8%) 32 (65.3%) 77 (68.1%) 37 (69.8%) 40 (66.7%) χ²=10.601 * p = 0.014 * χ²=5.902 * p = 0.015 * Dactylitis, n (%) 18 (12.6%) 7 (7.4%) 11 (22.4%) 27 (23.9%) 11 (20.8%) 16 (26.7%) χ²=11.252 * p = 0.011 * χ²=5.569 * p = 0.018 * Uveitis, n (%) 2 (1.4%) 2 (2.1%) 0 (0.0%) 1 (0.9%) 0 (0.0%) 1 (1.7%) χ²=1.617 MC p= 0.795 χ²=0.144 p=1.000 ESR (mm/h) Median (IQR) 24.0 (15.0 – 37) 22.50 (12.0 – 35.0) 25.0 (17.0 – 45.0) 23.0 (14.0 – 39.50) 23.0 (15.0 – 34.0) 25.0 (15.50 – 41.50) H=2.916 p = 0.405 U = 8041.5 p = 0.948 CRP (mg/L) Median (IQR) 5.90 (2.90 – 11.6) 12.0 (6.0 – 21.0) 7.10 (4.0 – 15.0) 11.30 (4.90 – 18.95) 7.0 (3.20 – 17.50) 4.95 (2.75 – 8.35) H= 19.741 * p<0.001 * U = 6075.5 * p<0.001 * Sig.bet.grps p 1 =0.027 * ,p 2 =0.026 * ,p 3 <0.001 * ,p 4 =0.969,p 5 =0.084,p 6 =0.071 BASDAI Median (IQR) 6.55 (5.50 – 7.6) 5.90 (4.80 – 6.80) 6.35 (5.15 – 7.80) 6.10 (5.0 – 7.30) 6.20 (5.0 – 6.80) 7.03 (6.18 – 7.90) H =18.09 * p<0.001 * U = 6922.5 p= 0.049 * Sig.bet.grps p 1 =0.032 * ,p 2 =0.700,p 3 <0.001 * ,p 4 =0.117,p 5 =0.155,p 6 =0.002 * BASFI 5.60 (4.25 – 7.3) 5.45 (3.60 – 7.0) 5.80 (4.80 – 7.70) 6.80 (5.40 – 7.90) 6.50 (5.0 – 7.90) 7.0 (5.90 – 7.90) H =19.779 * p<0.001 * U =5928.0 * p<0.001 * ASQoL 11 (5.50 – 14) 10.0 (5.0 – 13.0) 12.0 (9.0 – 16.0) 14.0 (9.0 – 16.0) 12.0 (9.0 – 16.0) 14.0 (10.0 – 16.0) H = 25.776 * p<0.001 * U= 5732.5 * p<0.001 * H: H for Kruskal Wallis test, U : Mann Whitney test, c 2 : Chi Square test, MC : Monte Carlo test p: p value for comparing between the four studied groups p 0 : p value for comparing between HLA-B27 Positive and negative p 1 : p value for comparing between G1 and G2 , p 2 : p value for comparing between G1 and G3 p 3 : p value for comparing between G1 and G4 , p 4 : p value for comparing between G2 and G3 p 5 : p value for comparing between G2 and G4 , p 6 : p value for comparing between G3 and G4 *: Statistically significant at p ≤ 0.05 Table (3): HLA-B27 and Disease Characteristics HLA-B27 Test of Sig. p Negative (n = 113) Positive (n = 143) No. % No. % Patterns of joint involvement Axial 19 16.8 39 27.3 χ 2 = 3.940 * 0.047 * Axial + Peripheral 94 83.2 104 72.7 Enthesitis No 36 31.9 67 46.9 χ 2 = 5.902 * 0.015 * Yes 77 68.1 76 53.1 Dactylitis No 86 76.1 125 87.4 χ 2 = 5.569 * 0.018 * Yes 27 23.9 18 12.6 Uveitis No 96 85.0 109 76.2 χ 2 = 3.017 0.082 Yes 17 15.0 34 23.8 ESR Mean ± SD. 28.10 ± 18.0 29.49 ± 20.84 U= 8041.500 0.948 Median (Min. – Max.) 24.0 (3.0 – 90.0) 23.0 (3.0 – 90.0) CRP Mean ± SD. 11.55 ± 15.42 13.79 ± 12.42 U= 6075.50 * 0.001 * Median (Min. – Max.) 5.90 (0.20 – 68.0) 11.30 (0.30 – 68.0) Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 12 May, 2026 Reviewers invited by journal 29 Apr, 2026 Editor assigned by journal 29 Apr, 2026 Editor invited by journal 27 Apr, 2026 Submission checks completed at journal 25 Apr, 2026 First submitted to journal 25 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9448653","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":634832531,"identity":"a49656a7-7188-48bd-ba9d-635aa040c221","order_by":0,"name":"Eiman Soliman","email":"","orcid":"","institution":"Faculty of Medicine, Alexandria University","correspondingAuthor":false,"prefix":"","firstName":"Eiman","middleName":"","lastName":"Soliman","suffix":""},{"id":634832532,"identity":"a2b4eeed-3155-4591-9399-b086821b822e","order_by":1,"name":"Magdy Zeheiry","email":"","orcid":"","institution":"Faculty of Medicine, Alexandria University","correspondingAuthor":false,"prefix":"","firstName":"Magdy","middleName":"","lastName":"Zeheiry","suffix":""},{"id":634832533,"identity":"ac5dac1f-68ba-493b-8ae0-2841cbcd6095","order_by":2,"name":"Yasmine Abu Halawa","email":"data:image/png;base64,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","orcid":"","institution":"Faculty of Medicine, Alexandria University","correspondingAuthor":true,"prefix":"","firstName":"Yasmine","middleName":"Abu","lastName":"Halawa","suffix":""},{"id":634832534,"identity":"2d2252ac-60c1-414c-b906-2e3505189102","order_by":3,"name":"Ahmed Shaaban","email":"","orcid":"","institution":"Faculty of Medicine, Alexandria University","correspondingAuthor":false,"prefix":"","firstName":"Ahmed","middleName":"","lastName":"Shaaban","suffix":""}],"badges":[],"createdAt":"2026-04-17 11:40:33","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9448653/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9448653/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108957079,"identity":"fd7e8386-b7ec-4032-ac41-346c70fe0e96","added_by":"auto","created_at":"2026-05-11 08:16:40","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":29791,"visible":true,"origin":"","legend":"\u003cp\u003eGender and Disease Activity, Spinal Mobility, Functional Limitation and Quality of Life.\u003c/p\u003e\n\u003cp\u003eHLA-B27 positive patients exhibited a greater tendency for axial involvement, while HLA-B27 negative individuals demonstrated higher rates of both axial and peripheral joint involvement. Enthesitis was more commonly observed in HLA-B27 negative patients, while dactylitis was also more prevalent among this group. Although uveitis was slightly more frequent in HLA-B27 positive patients, this difference did not reach statistical significance (Table 3). HLA-B27 positive patients exhibited higher CRP levels, whereas HLA-B27 negative individuals demonstrated greater disease activity (BASDAI), more pronounced functional impairment (BASFI), and poorer quality of life (ASQoL) (Figures 2–3).\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9448653/v1/79f74879e094bf5068c51a4e.jpeg"},{"id":108957170,"identity":"d1797d53-26dc-42fb-ad0f-eef8d46e347d","added_by":"auto","created_at":"2026-05-11 08:17:04","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":43543,"visible":true,"origin":"","legend":"\u003cp\u003eHLA-B27 and Disease Activity, Spinal Mobility, Functional Limitation and Quality of Life.\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9448653/v1/ebd4f4e3ec7d9e9235148026.jpeg"},{"id":108957132,"identity":"8c7890b0-4a05-451d-a551-ea00984cbcc2","added_by":"auto","created_at":"2026-05-11 08:16:53","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":37527,"visible":true,"origin":"","legend":"\u003cp\u003eCorrelation between ASQoL and ASDAS-CRP\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9448653/v1/990ecae67dc51bbf52f5f936.jpeg"},{"id":108957223,"identity":"30dd73e8-d3e9-48a0-85c6-7446a7f1c34f","added_by":"auto","created_at":"2026-05-11 08:17:17","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":599191,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9448653/v1/c0eb8d36-c95b-48f0-8c82-2d7d9ca5a1a0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Impact of Sex and HLA-B27 Positivity on Clinical Characteristics and Patient-Reported Outcomes in a Cohort of Egyptian Axial Spondyloarthritis Patients","fulltext":[{"header":"Background","content":"\u003cp\u003eAxial spondyloarthritis (axSpA) encompasses a heterogeneous group of inflammatory disorders primarily affecting the axial skeleton, distinguished by unique genetic, pathogenic, and clinical characteristics that differentiate them from other inflammatory arthritides. A hallmark feature of axSpA is chronic lower back pain, which typically manifests before the age of 45.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] This pain is of inflammatory origin and is frequently accompanied by other musculoskeletal manifestations, including enthesitis, peripheral arthritis, and, less commonly, dactylitis.[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] Furthermore, axSpA is frequently associated with extra-articular manifestations (EAMs), such as uveitis, psoriasis, and inflammatory bowel disease (IBD).[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eGenetic predisposition plays a critical role in axSpA, with the Human leukocyte antigen B27 (HLA-B27) demonstrating the strongest association with disease susceptibility. The presence of HLA-B27 increases the likelihood of developing axSpA by approximately 1.5 times compared to HLA-B27-negative individuals. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eBeyond genetic susceptibility, multiple factors contribute to the pathogenesis and progression of axSpA. Proinflammatory cytokines, particularly tumor necrosis factor-alpha (TNF-α) and interleukin-17 (IL-17), play a central role in sustaining inflammation and driving both pain and tissue damage.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] Additionally, emerging evidence suggests a connection between gut microbiota alterations and axSpA. These complex interactions not only shape disease expression but also influence treatment strategies and long-term outcomes.[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eHealth-related quality of life (HRQoL) in axSpA is significantly affected due to the disease burden and its treatment.[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] Patients frequently report chronic pain, progressive impairment of spinal mobility, fatigue even with minimal exertion, sleep disturbances, and psychological comorbidities such as depression, all of which contribute to a substantial reduction in overall well-being. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThis study aimed to assess the clinical characteristics, disease activity, functional status, treatment patterns, and HRQoL in a cohort of Egyptian patients with axSpA. Furthermore, we explored the associations between clinical characteristics and HLA-B27 status, along with differences in clinical presentation based on gender.\u003c/p\u003e"},{"header":"Subjects and Methods","content":"\u003cp\u003eThis study employed a cross-sectional observational design conducted over a 12-month period in the Rheumatology Unit, Alexandria University Hospital. 256 Egyptian patients fulfilling the Assessment of SpondyloArthritis International Society (ASAS) classification criteria were recruited. Patients with comorbid IBD and psoriatic arthritis (PsA) were excluded from the study. This study was approved by the Ethical Committee of the Faculty of Medicine, Alexandria University.\u003c/p\u003e \u003cp\u003ePrior to baseline examination, each patient was to be interrogated thoroughly about symptoms, onset, course and duration of the disease, co-morbid illness, extra articular manifestations, and family history. HLA-B27 status was determined from patient medical records. Patients were asked to fill in the ASQoL questionnaire [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The questionnaire includes items related to the impact of disease on sleep, mood, motivation, coping, activities of daily living, independence, relationships, and social life. Scoring is in dichotomous responses, with 0 scored for a \u0026ldquo;no\u0026rdquo; and 1 scored for a \u0026ldquo;yes\u0026rdquo; for each item.\u003c/p\u003e \u003cp\u003eTotal score is the sum of the individual responses. Score range is 0\u0026ndash;18, with higher scores reflecting greater impairment of HrQoL.\u003c/p\u003e \u003cp\u003eLaboratory investigations included a complete blood picture (CBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), serum creatinine, aspartate aminotransferase (AST) and alanine transaminase (ALT) as well as HLA-B27 testing.\u003c/p\u003e \u003cp\u003eImaging choices in this study were primarily determined by availability and cost, with most patients proceeding directly to (MRI) of the sacroiliac (SI) joints, while a smaller proportion underwent plain radiography (X-Ray). MRI utilization was mainly influenced by insurance authorization policies and the requirement of MRI confirmation for medication approval.\u003c/p\u003e \u003cp\u003eSacroiliitis was considered positive if X-rays showed at least grade 2 bilaterally or grade 3 unilaterally, according to the modified New York criteria [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], or if MRI findings fulfilled the ASAS definition for active sacroiliitis, which requires the presence of bone marrow edema (BME) in typical subchondral locations on at least two consecutive slices or multiple lesions on a single slice, consistent with inflammatory activity .[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eDisease activity was evaluated using Ankylosing Spondylitis Disease Activity Score using C-reactive protein (ASDAS-CRP) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Functional impairment was assessed through the Bath Ankylosing Spondylitis Functional Index (BASFI) and spinal mobility was assessed using the Bath Ankylosing Spondylitis Metrology Index (BASMI). Patient-reported outcomes were obtained using the ASQoL questionnaire. [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eGender and HLA-B27 status were the primary variables of interest, and their relationship with disease activity, functional impairment, spinal mobility, and patient-reported outcomes were analyzed.\u003c/p\u003e \u003cp\u003eData were entered and analyzed using IBM SPSS Statistics software version 20.0 (Armonk, NY: IBM Corp). Qualitative variables were summarized as frequencies and percentages, while the normality of quantitative data distribution was assessed using the Kolmogorov-Smirnov test. Quantitative variables were presented as range (minimum and maximum), mean, standard deviation, median, and interquartile range (IQR). A significance level of 5% was used to determine statistical significance.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThis study included 256 patients, comprising 147 males (57.4%) and 109 females (42.6%). HLA-B27 positivity was observed in 143 patients (55.9%), while 113 patients (44.1%) were HLA-B27 negative. Of the total cohort, 76 patients (29.7%) were classified as nr-axSpA, whereas 180 patients (70.3%) were classified as r-axSpA.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;1 presents the sociodemographic, clinical, and disease-specific measures of the study population. The mean BASDAI and BASFI scores for the total cohort were 6.12\u0026thinsp;\u0026plusmn;\u0026thinsp;1.74 and 6.05\u0026thinsp;\u0026plusmn;\u0026thinsp;2.03, respectively, reflecting a high disease burden overall.\u003c/p\u003e \u003cp\u003eWhen analyzed by gender, female patients exhibited significantly higher disease activity and functional impairment (median BASDAI\u0026thinsp;=\u0026thinsp;7.03 [IQR 6.18\u0026ndash;7.90] vs. 6.20 [IQR 5.0\u0026ndash;6.80], \u003cem\u003ep\u0026thinsp;=\u0026thinsp;0.049\u003c/em\u003e; median BASFI\u0026thinsp;=\u0026thinsp;7.0 [IQR 5.90\u0026ndash;7.90] vs. 6.50 [IQR 5.0\u0026ndash;7.90], \u003cem\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/em\u003e) and a lower quality of life (ASQoL\u0026thinsp;=\u0026thinsp;14.0 [IQR 10.0\u0026ndash;16.0] vs. 12.0 [IQR 9.0\u0026ndash;16.0], \u003cem\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/em\u003e) compared to males.\u003c/p\u003e \u003cp\u003eIn contrast, male patients were more likely to exhibit axial-only involvement (33.0% vs. 16.3%, \u003cem\u003ep\u0026thinsp;=\u0026thinsp;0.047\u003c/em\u003e), while females had higher rates of combined axial and peripheral joint involvement and more frequent dactylitis (22.4% vs. 7.4%, \u003cem\u003ep\u0026thinsp;=\u0026thinsp;0.018\u003c/em\u003e). The occurrence of uveitis and enthesitis did not differ significantly between genders (\u003cem\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/em\u003e).\u003c/p\u003e \u003cp\u003eThese findings are detailed in Table\u0026nbsp;2 (Gender-Stratified Analysis of HLA-B27 Positive and Negative Patients) and illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, which depicts the correlation between gender and disease activity, functional limitation, spinal mobility, and quality of life.\u003c/p\u003e \u003cp\u003eMale patients were more likely to have axial-only involvement, whereas females commonly exhibited both axial and peripheral joint involvement. Females also showed higher rates of dactylitis, although the incidence of enthesitis did not differ significantly between sexes. Uveitis occurrence was similar between males and females. (Table\u0026nbsp;2) Additionally, females reported higher disease activity (BASDAI), functional impairment (BASFI), and poorer quality of life (ASQoL). (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFigure (1): Gender and Disease Activity, Spinal Mobility, Functional Limitation and Quality of Life.\u003c/p\u003e \u003cp\u003eHLA-B27 positive patients exhibited a greater tendency for axial involvement, while HLA-B27 negative individuals demonstrated higher rates of both axial and peripheral joint involvement. Enthesitis was more commonly observed in HLA-B27 negative patients, while dactylitis was also more prevalent among this group. Although uveitis was slightly more frequent in HLA-B27 positive patients, this difference did not reach statistical significance (Table\u0026nbsp;3). HLA-B27 positive patients exhibited higher CRP levels, whereas HLA-B27 negative individuals demonstrated greater disease activity (BASDAI), more pronounced functional impairment (BASFI), and poorer quality of life (ASQoL) (Figs.\u0026nbsp;2\u0026ndash;3).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFigure (2): HLA-B27 and Disease Activity, Spinal Mobility, Functional Limitation and Quality of Life.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFigure (3) Correlation between ASQoL and ASDAS-CRP\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAxial SpA is a heterogeneous inflammatory disorder primarily affecting the axial skeleton, with chronic lower back pain as a hallmark feature and frequent musculoskeletal and extra-articular manifestations such as enthesitis, uveitis, and IBD. Genetic predisposition, particularly the strong association with HLA-B27, alongside proinflammatory cytokines like TNF-α and IL-17, play key roles in disease pathogenesis, with emerging evidence suggesting gut microbiota involvement. The chronic inflammation and disease burden significantly impact HRQoL, contributing to pain, spinal mobility impairment, fatigue, sleep disturbances, and psychological comorbidities.\u003c/p\u003e \u003cp\u003eOur study found that 55.9% of axSpA patients were HLA-B27 positive, aligning with Tayel et al.[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] at 58.7% and Poddubny et al.[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] at 57.6%. However, according to Poddubny et al.[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], HLA-B27 prevalence varies significantly by region, with Europe showing the highest positivity (80.3%) and Canada the lowest (29.4%). This emphasizes the need for geographically diverse registries to better understand axSpA genetics.\u003c/p\u003e \u003cp\u003eAdditionally, HLA-B27 positivity was significantly higher in males (63.9%) than females (45.0%) (p\u0026thinsp;=\u0026thinsp;0.002), consistent with findings from Blasco-Blasco et al.[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] These gender differences suggest that genetic factors influence disease susceptibility, clinical presentation, and progression, potentially affecting arthritis patterns and associated symptoms.\u003c/p\u003e \u003cp\u003eThis analysis unveiled intriguing patterns in the relationship between HLA-B27 and arthritis manifestations, revealing that HLA-B27 negative patients exhibited a higher prevalence of both axial and peripheral arthritis, with 83.2% of these individuals presenting dual manifestations compared to 72.7% of HLA-B27 positive patients (p\u0026thinsp;=\u0026thinsp;0.047). This observation resonates with Zhang et al.\u0026rsquo;s [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] findings, which indicated elevated rates of peripheral arthritis among HLA-B27 negative patients (36.2% vs. 27.0%, p\u0026thinsp;=\u0026thinsp;0.001), highlighting a nuanced interplay between HLA-B27 negativity and the broader spectrum of arthritis.\u003c/p\u003e \u003cp\u003eComplementing these insights, this work also uncovered marked gender disparities in arthritis patterns. Males reported significantly higher incidences of low back pain (30.6%) compared to females (11.9%) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), while peripheral arthritis was more prevalent among females (88.1%) than males (69.4%). These observations are in line with Almousa et al.'s [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] research, which documented a higher prevalence of peripheral arthritis in females (38.8% vs. 14.5%, p\u0026thinsp;=\u0026thinsp;0.007) and greater rates of low back pain in males (69.7% vs. 23.7%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eOur analysis further revealed that HLA-B27 positive patients exhibited a lower prevalence of enthesitis compared to their HLA-B27 negative counterparts (53.1% vs. 68.1%, p\u0026thinsp;=\u0026thinsp;0.015). This trend is consistent with Zhang et al.\u0026rsquo;s [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] report, which also noted a lower prevalence among HLA-B27 positive patients, though the difference was not statistically significant (64.6% vs. 68.1%, p\u0026thinsp;=\u0026thinsp;0.146).\u003c/p\u003e \u003cp\u003eThe study also unveiled a notable trend towards a higher prevalence of enthesitis among females (66.1%) in comparison to males (55.1%), although this difference did not reach statistical significance (p\u0026thinsp;=\u0026thinsp;0.077). Blasco-Blasco et al.\u0026rsquo;s [15)] meta-analysis, utilizing the Maastricht Ankylosing Spondylitis Enthesitis Score (MASES), also revealed slightly higher scores for females (2.5) compared to males (1.7), although this discrepancy was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.23).\u003c/p\u003e \u003cp\u003eIt should be noted that clinically evaluating enthesitis presents significant challenges due to its multifaceted nature, which can stem from mechanical injury or conditions like fibromyalgia. Some entheses are notably difficult to assess, and the absence of localized pain does not definitively rule out the presence of enthesitis. Reported prevalence rates may not truly capture the condition's full extent, implying that the actual incidence might be higher than currently recognized.\u003c/p\u003e \u003cp\u003eConsidering uveitis, the present study observed that uveitis was present in 22.9% of females and 17.7% of males, with no statistically significant gender difference (p\u0026thinsp;=\u0026thinsp;0.299). This finding diverges from the meta-analysis by Blasco-Blasco et al.[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], which reported a higher frequency of uveitis in males, aligning with other studies suggesting a male predominance. The observed discrepancy may be attributable to the presence of a multidisciplinary uveitis clinic within our study setting, which may have introduced a bias in our findings. This factor could account for the divergence from the male predominance in uveitis reported in other studies.\u003c/p\u003e \u003cp\u003eTo gain a deeper understanding of disease severity and inflammation in axSpA, it is crucial to examine how gender and HLA-B27 may influence key markers such as CRP and disease activity indices. By investigating these relationships, we can better interpret how systemic inflammation and disease activity differ between genders and HLA-B27. This exploration will provide a more comprehensive view of how these factors contribute to the overall disease burden and inform more tailored approaches to treatment and management in axSpA.\u003c/p\u003e \u003cp\u003eAlthough both gender and HLA-B27 status affect CRP levels, these factors do not seem to impact ASDAS-CRP scores. Benavent et al. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] reported that gender had no significant effect on ASDAS-CRP, showing minimal gender-related variation in ASDAS-CRP scores within their cohort. consistent with these findings, our study similarly reports no significant gender-based differences in ASDAS-CRP scores, with mean values of 4.53 for males and 4.60 for females (p\u0026thinsp;=\u0026thinsp;0.823). Both investigations therefore converge on the conclusion that gender does not substantially affect ASDAS in axSpA.\u003c/p\u003e \u003cp\u003eHowever, significant gender disparities were observed in BASDAI scores, with women consistently reporting higher scores than men across both our study and Tournadre et al.\u0026rsquo;s[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] studies. This suggests that while objective measures like ASDAS-CRP may reflect comparable disease activity between genders, subjective assessments such as BASDAI highlight a perceived higher disease burden among women with axSpA.\u003c/p\u003e \u003cp\u003eIn regard to HLA-B27 however, Ar\u0026eacute;valo et al. [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] documented a significant increase in ASDAS-CRP scores for HLA-B27 positive patients (mean\u0026thinsp;=\u0026thinsp;1.96) compared to HLA-B27 negative individuals (mean\u0026thinsp;=\u0026thinsp;2.09), with a p-value of 0.002, highlighting a pronounced link between HLA-B27 positivity and elevated disease activity. Conversely, our analysis found no significant difference in ASDAS-CRP scores between HLA-B27 positive (mean\u0026thinsp;=\u0026thinsp;4.53) and HLA-B27 negative patients (mean\u0026thinsp;=\u0026thinsp;4.60), with a p-value of 0.638. This suggests that, within our cohort, HLA-B27 status does not significantly affect disease activity as assessed by ASDAS-CRP.\u003c/p\u003e \u003cp\u003eThe mean ASDAS-CRP in this cohort was notably high (4.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91), reflecting very high disease activity across the study population. This value exceeds those reported in several international cohorts, where mean ASDAS-CRP values typically range between 2.5 and 3.5. Several factors may explain this difference. First, patients in our cohort had a prolonged diagnostic delay (mean 8.5 years), which likely contributed to accumulated disease burden and functional impairment at presentation. Second, the study population was recruited from a tertiary referral center, where patients tend to have more severe or treatment-resistant disease. Third, limited access to early biologic therapy and variations in healthcare coverage may have delayed optimal treatment initiation. Finally, genetic and environmental influences unique to the regional population could also contribute to heightened inflammatory activity.\u003c/p\u003e \u003cp\u003eThe discrepancy between our findings and those of Ar\u0026eacute;valo et al. [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], who reported significantly higher ASDAS-CRP values among HLA-B27\u0026ndash;positive patients, may partly reflect differences in overall disease activity between cohorts. In our study, the mean ASDAS-CRP was substantially higher (4.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91) compared with approximately 2.0 in the Ar\u0026eacute;valo et al. cohort. This markedly elevated baseline activity could have attenuated or masked potential differences between HLA-B27 subgroups, as inflammatory burden was uniformly high across the study population. Moreover, cohort differences in disease duration, referral patterns, and treatment exposure may have further contributed to the divergent findings.\u003c/p\u003e \u003cp\u003eHealth related quality of life assessments in axSpA are critical for understanding the comprehensive impact of the disease on patients. In comparing quality of life, our study and findings from Mease et al.[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], significant differences emerge, particularly regarding gender disparities.\u003c/p\u003e \u003cp\u003eOur work reveals higher ASQoL scores among females, indicating poorer health-related quality of life compared to males. Mease et al.'s [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] broader assessment corroborates these findings, showing that females consistently report higher levels of pain, fatigue, and disability, along with lower overall health scores compared to males. These findings highlight the persistent gender-based disparities in axSpA, highlighting the importance of tailored interventions that address these specific quality of life challenges faced by female patients.\u003c/p\u003e \u003cp\u003eThe results also indicated that HLA-B27 positive patients had significantly lower ASQoL scores (mean 10.18) compared to HLA-B27 negative patients (mean 12.66), with a p-value of less than 0.001. Lower ASQoL scores indicate better HRQoL, suggesting that HLA-B27 positive patients in our study report a better quality of life. This may be explained by the presence of less dactylitis and peripheral arthritis in HLA-B27 positive patients, as compared to HLA-B27 negative patients.\u003c/p\u003e \u003cp\u003eIn Carvalho et al.'s [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] SpA study, they explored how ASDAS-CRP impacts HRQoL assessed by EQ-5D-3L (EuroQol 5-Dimensional 3-Level). Their research highlighted a notable inverse relationship: higher ASDAS-CRP scores were significantly associated with lower HRQoL (adjusted B = -0.052, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), highlighting the detrimental effect of increased disease activity on quality of life. Similarly, in our investigation, we observed a meaningful positive correlation between ASQoL and ASDAS-CRP (rs\u0026thinsp;=\u0026thinsp;0.277, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This suggests that heightened disease activity aligns with diminished quality of life scores, reinforcing the critical impact of disease management on patient well-being.\u003c/p\u003e \u003cp\u003eBoth our work and Sallam et al.'s [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] study consistently demonstrate a significant correlation between higher BASDAI scores and poorer quality of life outcomes in patients with axSpA. In our study, the correlation coefficient was 0.650 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), while Sallam et al.'s [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] study reported a regression coefficient of 1.08 (p\u0026thinsp;=\u0026thinsp;0.02), emphasizing the negative impact of increased disease activity on patient well-being. These findings highlight the critical need for effective disease management to enhance quality of life.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eAxial spondyloarthritis (axSpA) demonstrates considerable clinical heterogeneity influenced by demographic factors, genetic predisposition\u0026mdash;particularly HLA-B27 status\u0026mdash;and diverse disease manifestations, underscoring the need for individualized diagnostic and management strategies. Gender differences are evident, with women often exhibiting a higher overall disease burden and more frequent peripheral involvement, including dactylitis. These findings highlight the importance of gender-sensitive care, including a lower threshold for investigating peripheral joint symptoms in women to prevent underdiagnosis and delayed treatment. HLA-B27 positivity appears to modulate disease expression, being associated with better quality of life and lower frequencies of enthesitis, peripheral arthritis, and dactylitis. Given the profound impact of axSpA on functional capacity and quality of life, comprehensive, holistic management\u0026mdash;addressing not only inflammation and pain but also sleep disturbances, fatigue, fibromyalgia, and psychosocial well-being\u0026mdash;is essential to optimize long-term outcomes.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eAxSpA\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAxial spondyloarthritis\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eHLA-B27\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHuman leukocyte antigen B27\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eASDAS-CRP\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAnkylosing Spondylitis Disease Activity Score using C-reactive protein\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eBASDAI\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBath Ankylosing Spondylitis Disease Activity Index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eBASMI\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBath Ankylosing Spondylitis Metrology Index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eBASFI\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBath Ankylosing Spondylitis Functional Index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eASQoL\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAnkylosing Spondylitis Quality of Life\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eEAM\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eExtra-articular manifestations\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eIBD\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInflammatory bowel disease\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eTNF\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTumor necrosis factor\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eIL\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInterleukin\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eASAS\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAssessment of SpondyloArthritis International Society\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003ePsA\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePsoriatic arthritis\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eCBC\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eComplete blood count\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eESR\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eErythrocyte sedimentation rate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eCRP\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eC-reactive protein\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eAST\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAspartate aminotransferase\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eALT\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAlanine aminotransferase\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eSI\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSacroiliac\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eMRI\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMagnetic resonance imaging\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eX-Ray\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePlain Radiography\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eBME\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBone marrow edema\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cstrong\u003eClinical trial number\u003c/strong\u003e \u003cp\u003enot applicable.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003eThe study was approved by the Ethics Committee of the Faculty of Medicine, Alexandria University (Approval No. 0107729). Written informed consent was obtained from all participants prior to their inclusion in the study. All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCompeting interests\u003c/strong\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eEiman Soliman, Yasmine Abu Halawa, Magdy Zeheiry, and Ahmed Shaaban all contributed equally to the study\u0026rsquo;s conception, design, data collection, analysis, interpretation, and manuscript preparation. All authors read and approved the final version of the manuscript\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors would like to thank the staff of the Rheumatology and Clinical Immunology Division, Alexandria University, for their support and assistance throughout the study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available due to institutional regulations and patient confidentialitybut are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSieper J, Rudwaleit M, Baraliakos X, Brandt J, Burgos-Vargas R, Dougados M, et al. The Assessment of Spondyloarthritis International Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis. 2009;68:1\u0026ndash;44. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1136/ard.2008.104018\u003c/span\u003e\u003cspan address=\"10.1136/ard.2008.104018\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYu DT, van Tubergen A. Overview of the clinical manifestations and classification of spondyloarthritis. In: Connor RF, editor. \u003cem\u003eUpToDate.\u003c/em\u003e Wolters Kluwer; [cited 2024 Apr 14].\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEl Maghraoui A. Extra-articular manifestations of ankylosing spondylitis: prevalence, characteristics, and therapeutic implications. Eur J Intern Med. 2011;22(6):554\u0026ndash;60. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ejim.2011.06.006\u003c/span\u003e\u003cspan address=\"10.1016/j.ejim.2011.06.006\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYu DT, van Tubergen A. Pathogenesis of spondyloarthritis. In: Connor RF, editor. \u003cem\u003eUpToDate.\u003c/em\u003e Wolters Kluwer; [cited 2023 Mar 28].\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLin H, Gong YZ. Association of HLA-B27 with ankylosing spondylitis and clinical features of the HLA-B27-associated ankylosing spondylitis: a meta-analysis. Rheumatol Int. 2017;37(8):1267\u0026ndash;80. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00296-017-3741-2\u003c/span\u003e\u003cspan address=\"10.1007/s00296-017-3741-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCeribelli A, Motta F, Vecellio M, Isailovic N, Ciccia F, Selmi C. Clinical trials supporting the role of the IL-17/IL-23 axis in axial spondyloarthritis. Front Immunol. 2021;12:622770. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fimmu.2021.622770\u003c/span\u003e\u003cspan address=\"10.3389/fimmu.2021.622770\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJacques P, van Praet L, Carron P, Van den Bosch F, Elewaut D. Pathophysiology and role of the gastrointestinal system in spondyloarthritides. Rheum Dis Clin North Am. 2012;38(3):569\u0026ndash;82. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.rdc.2012.08.012\u003c/span\u003e\u003cspan address=\"10.1016/j.rdc.2012.08.012\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDoward LC, Spoorenberg A, Cook SA, Whalley D, Helliwell PS, Kay LJ et al. Development of the ASQoL: a quality of life instrument specific to ankylosing spondylitis. Ann Rheum Dis [cited 2023 Jun 2]. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1136/ard.62.1.20\u003c/span\u003e\u003cspan address=\"10.1136/ard.62.1.20\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKiltz U, Braun J. Assessments of functioning in patients with axial spondyloarthritis. J Rheum Dis. 2020;27(1):22\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.4078/jrd.2020.27.1.22\u003c/span\u003e\u003cspan address=\"10.4078/jrd.2020.27.1.22\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVan der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. Arthritis Rheum. 1984;27(4):361\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/art.1780270401\u003c/span\u003e\u003cspan address=\"10.1002/art.1780270401\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLambert RGW, Bakker PAC, Van Der Heijde D, Weber U, Rudwaleit M, Hermann KGA, et al. Defining active sacroiliitis on MRI for classification of axial spondyloarthritis: update by the ASAS MRI working group. Ann Rheum Dis. 2016;75(11):1958\u0026ndash;63. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1136/annrheumdis-2015-208642\u003c/span\u003e\u003cspan address=\"10.1136/annrheumdis-2015-208642\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZochling J. Measures of symptoms and disease status in ankylosing spondylitis: Ankylosing Spondylitis Disease Activity Score (ASDAS), Ankylosing Spondylitis Quality of Life Scale (ASQoL), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Global Score (BAS-G), Bath Ankylosing Spondylitis Metrology Index (BASMI), Dougados Functional Index (DFI), and Health Assessment Questionnaire for the Spondylarthropathies (HAQ-S). Arthritis Care Res (Hoboken). 2011;63(S11):S47\u0026ndash;58. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/acr.20575\u003c/span\u003e\u003cspan address=\"10.1002/acr.20575\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTayel MY, Soliman E, El Baz WF, El Labaan A, Hamaad Y, Ahmed MH. Registry of the clinical characteristics of spondyloarthritis in a cohort of Egyptian population. Rheumatol Int. 2012;32:2837\u0026ndash;42. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00296-011-2068-7\u003c/span\u003e\u003cspan address=\"10.1007/s00296-011-2068-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePoddubnyy D, Sieper J, Akar S, Mu\u0026ntilde;oz-Fern\u0026aacute;ndez S, Haibel H, Hojnik M, et al. Characteristics of patients with axial spondyloarthritis by geographic regions: PROOF multicountry observational study baseline results. Rheumatology. 2022;61(8):3299\u0026ndash;308. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1093/rheumatology/keab901\u003c/span\u003e\u003cspan address=\"10.1093/rheumatology/keab901\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBlasco-Blasco M, Castrej\u0026oacute;n I, Jovan\u0026iacute; V, Pascual E, Ruiz-Cantero MT. Reviewing disease activity indices in spondyloarthritis from the sex perspective: a systematic review and meta-analysis. J Rheumatol. 2021;48(9):1395\u0026ndash;404. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3899/jrheum.200967\u003c/span\u003e\u003cspan address=\"10.3899/jrheum.200967\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang S, Wang Y, Peng L, Su J, Zeng X, Li M, et al. Comparison of clinical features in HLA-B27 positive and negative patients with axial spondyloarthritis: results from a cohort of 4,131 patients. Front Med (Lausanne). 2020;7:609562. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fmed.2020.609562\u003c/span\u003e\u003cspan address=\"10.3389/fmed.2020.609562\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlmousa S, Alshamaa N, Wannous H, Khder K, Qasem H. Gender-related differences in axial spondyloarthritis (axSpA) patients. Egypt Rheumatologist. 2023;45(1):13\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ejr.2022.08.003\u003c/span\u003e\u003cspan address=\"10.1016/j.ejr.2022.08.003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBenavent D, Capelusnik D, Ramiro S, Molto A, L\u0026oacute;pez-Medina C, Dougados M, et al. Does gender influence outcome measures similarly in patients with spondyloarthritis? Results from the ASAS-perSpA study. RMD Open. 2022;8(2):e002514. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1136/rmdopen-2022-002514\u003c/span\u003e\u003cspan address=\"10.1136/rmdopen-2022-002514\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTournadre A, Pereira B, Lhoste A, Dubost JJ, Ristori JM, Claudepierre P, et al. Differences between women and men with recent-onset axial spondyloarthritis: results from a prospective multicenter French cohort. Arthritis Care Res (Hoboken). 2013;65(9):1482\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/acr.22001\u003c/span\u003e\u003cspan address=\"10.1002/acr.22001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAr\u0026eacute;valo M, L\u0026oacute;pez-Medina C, Moreno Martinez-Losa M, Molt\u0026oacute; A, Font P, Collantes-Estevez E, et al. Role of HLA-B27 in the comorbidities observed in axial spondyloarthritis: data from COMOSPA. Joint Bone Spine. 2020;87(5):445\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jbspin.2020.03.012\u003c/span\u003e\u003cspan address=\"10.1016/j.jbspin.2020.03.012\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMease PJ, McLean RR, Dube B, Liu M, Rebello S, Glynn M, et al. Comparison of men and women with axial spondyloarthritis in the US-based Corrona Psoriatic Arthritis/Spondyloarthritis Registry. J Rheumatol. 2021;48(10):1528\u0026ndash;36. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3899/jrheum.201549\u003c/span\u003e\u003cspan address=\"10.3899/jrheum.201549\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCarvalho PD, Vieira-Sousa E, Hmamouchi I, Marreiros A, Machado PM. Determinants of health-related quality of life in spondyloarthritis and rheumatoid arthritis - data from the COMOSPA and COMORA studies. Semin Arthritis Rheum. 2022;57:152086. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.semarthrit.2022.152086\u003c/span\u003e\u003cspan address=\"10.1016/j.semarthrit.2022.152086\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSallam RA, Elbahnasawy AS. Health-related quality of life (HRQoL) in ankylosing spondylitis patients: relation to clinical features, disease activity, and radiographic damage. Egypt Rheumatologist. 2020;42(4):287\u0026ndash;90. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ejr.2020.02.006\u003c/span\u003e\u003cspan address=\"10.1016/j.ejr.2020.02.006\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable (1) Sociodemographic, clinical, and disease specific measures in patients with axSpA.\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"567\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 283px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDemographic data\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e147\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e57.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 42.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003eMin. \u0026ndash; Max.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e17.0 \u003cspan dir=\"RTL\"\u003e\u0026ndash;\u003c/span\u003e 70.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e22.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e38.85 \u003cspan dir=\"RTL\"\u003e\u0026plusmn;\u003c/span\u003e 9.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e77.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e38.50 (32.0 \u003cspan dir=\"RTL\"\u003e\u0026ndash;\u003c/span\u003e 45.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e59.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026plusmn; SD.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMin\u0026ndash;Max\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 283px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge of disease onset (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e26.37 \u0026plusmn; 7.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e15.0 \u0026ndash; 50.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 283px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge at diagnosis (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e34.85 \u0026plusmn; 9.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e16.0 \u0026ndash; 60.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 283px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiagnosis Gap (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e8.48 \u0026plusmn; 7.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e0.0 \u0026ndash; 28.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSmoking\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Non-Smoker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e172\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e67.18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Smoker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e24.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Ex-Smoker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e8.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily history\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e78.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e21.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 283px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 283px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; Biologics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e180\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e70.3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 283px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Secukinumab\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e24.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 283px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Adalimumab Biosimilar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e16.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 283px;\"\u003e\n \u003cp\u003e\u0026nbsp; Adalimumab\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e11.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 283px;\"\u003e\n \u003cp\u003e\u0026nbsp; Golimumab\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e10.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 283px;\"\u003e\n \u003cp\u003e\u0026nbsp; Etanercept\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e7.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 283px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; Non-Biological Treatment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e76\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e29.7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 283px;\"\u003e\n \u003cp\u003e\u0026nbsp; NSAIDs\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e28.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 283px;\"\u003e\n \u003cp\u003e\u0026nbsp; cDMARDs alone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMin. \u0026ndash; Max\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026plusmn; SD.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 283px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCRP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e12.81 \u003cstrong\u003e\u003cspan dir=\"RTL\"\u003e\u0026plusmn;\u003c/span\u003e\u003c/strong\u003e 13.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e0.20 \u003cstrong\u003e\u003cspan dir=\"RTL\"\u003e\u0026ndash;\u003c/span\u003e\u003c/strong\u003e 68.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 283px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eASDAS-CRP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e4.56 \u0026plusmn; 0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e1.75 \u0026ndash; 6.45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 283px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBASDAI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e6.12 \u003cspan dir=\"RTL\"\u003e\u0026plusmn;\u003c/span\u003e 1.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e1.40 \u003cspan dir=\"RTL\"\u003e\u0026ndash;\u003c/span\u003e 9.75\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 283px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBASFI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e6.05 \u003cspan dir=\"RTL\"\u003e\u0026plusmn;\u003c/span\u003e 2.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e1.50 \u003cspan dir=\"RTL\"\u003e\u0026ndash;\u003c/span\u003e 10.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 283px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBASMI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e4.48 \u003cspan dir=\"RTL\"\u003e\u0026plusmn;\u003c/span\u003e 2.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e0.0 \u0026ndash; 10.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 283px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eASQol\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e11.28 \u003cspan dir=\"RTL\"\u003e\u0026plusmn;\u003c/span\u003e 4.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e0.0 \u0026ndash; 18.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eTable (2): Gender-Stratified Analysis of HLA-B27 Positive and Negative Patients\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"936\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParameter\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal positive\u003cbr\u003e\u0026nbsp;(n = 143)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 171px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHLA-B27 Positive\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003cbr\u003e\u0026nbsp;Negative\u003cbr\u003e\u0026nbsp;(n = 113)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 171px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHLA-B27 Negative\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTest of Sig\u003cbr\u003e\u0026nbsp;p-value.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003csub\u003e0\u003c/sub\u003e\u003cbr\u003e\u0026nbsp;HLA-B27 Positive VS negative\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMales\u0026nbsp;\u003cbr\u003e\u0026nbsp;(n= 94)\u003cbr\u003e\u0026nbsp;G1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemales\u0026nbsp;\u003cbr\u003e\u0026nbsp;(n= 49)\u003cbr\u003e\u0026nbsp;G2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMales\u0026nbsp;\u003cbr\u003e\u0026nbsp;(n= 53)\u003cbr\u003e\u0026nbsp;G3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemales\u0026nbsp;\u003cbr\u003e\u0026nbsp;(n= 60)\u003cbr\u003e\u0026nbsp;G4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePattern of joint involvement\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e- Axial only, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e39 (27.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e31 (33.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e8 (16.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e19 (16.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e14 (26.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e5 (8.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2;=14.28\u003csup\u003e*\u003cbr\u003e\u0026nbsp;\u003c/sup\u003ep = 0.003\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2;=3.940\u003csup\u003e*\u003c/sup\u003e\u003cbr\u003ep = 0.047\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e- Axial + Peripheral, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e104 (72.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e63 (67.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e41 (83.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e94 (83.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e39 (73.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e55 (91.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEnthesitis, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e76 (53.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e44 (46.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e32 (65.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e77 (68.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e37 (69.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e40 (66.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2;=10.601\u003csup\u003e*\u003c/sup\u003e\u003cbr\u003ep = 0.014\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2;=5.902\u003csup\u003e*\u003c/sup\u003e\u003cbr\u003ep = 0.015\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDactylitis, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e18 (12.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e7 (7.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e11 (22.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e27 (23.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e11 (20.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e16 (26.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2;=11.252\u003csup\u003e*\u003c/sup\u003e\u003cbr\u003ep = 0.011\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2;=5.569\u003csup\u003e*\u003c/sup\u003e\u003cbr\u003ep = 0.018\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUveitis, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e2 (1.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e2 (2.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e1 (0.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e1 (1.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2;=1.617\u003cbr\u003e\u003csup\u003eMC\u003c/sup\u003ep= 0.795\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2;=0.144\u003cbr\u003e\u0026nbsp;p=1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eESR (mm/h)\u003c/strong\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;Median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e24.0\u0026nbsp;\u003cbr\u003e\u0026nbsp;(15.0 \u0026ndash; 37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e22.50\u0026nbsp;\u003cbr\u003e\u0026nbsp;(12.0 \u0026ndash; 35.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e25.0\u0026nbsp;\u003cbr\u003e\u0026nbsp;(17.0 \u0026ndash; 45.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e23.0\u0026nbsp;\u003cbr\u003e\u0026nbsp;(14.0 \u0026ndash; 39.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e23.0\u0026nbsp;\u003cbr\u003e\u0026nbsp;(15.0 \u0026ndash; 34.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e25.0\u0026nbsp;\u003cbr\u003e\u0026nbsp;(15.50 \u0026ndash; 41.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003eH=2.916\u003cbr\u003e\u0026nbsp;p = 0.405\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eU = 8041.5\u003cbr\u003e\u0026nbsp;p = 0.948\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCRP (mg/L)\u003c/strong\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;Median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e5.90\u0026nbsp;\u003cbr\u003e\u0026nbsp;(2.90 \u0026ndash; 11.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e12.0 (6.0 \u0026ndash; 21.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e7.10 (4.0 \u0026ndash; 15.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e11.30\u003cbr\u003e\u0026nbsp; (4.90 \u0026ndash; 18.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e7.0\u0026nbsp;\u003cbr\u003e\u0026nbsp;(3.20 \u0026ndash; 17.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e4.95\u0026nbsp;\u003cbr\u003e\u0026nbsp;(2.75 \u0026ndash; 8.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003eH= 19.741\u003csup\u003e*\u003cbr\u003e\u0026nbsp;\u003c/sup\u003ep\u0026lt;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eU = 6075.5\u003csup\u003e*\u003c/sup\u003e\u003cbr\u003ep\u0026lt;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSig.bet.grps\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" style=\"width: 427px;\"\u003e\n \u003cp\u003ep\u003csub\u003e1\u003c/sub\u003e=0.027\u003csup\u003e*\u003c/sup\u003e,p\u003csub\u003e2\u003c/sub\u003e=0.026\u003csup\u003e*\u003c/sup\u003e,p\u003csub\u003e3\u003c/sub\u003e\u0026lt;0.001\u003csup\u003e*\u003c/sup\u003e,p\u003csub\u003e4\u003c/sub\u003e=0.969,p\u003csub\u003e5\u003c/sub\u003e=0.084,p\u003csub\u003e6\u003c/sub\u003e=0.071\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBASDAI\u003cbr\u003e\u003c/strong\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e6.55\u0026nbsp;\u003cbr\u003e\u0026nbsp;(5.50 \u0026ndash; 7.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e5.90\u003cbr\u003e\u0026nbsp; (4.80 \u0026ndash; 6.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e6.35\u0026nbsp;\u003cbr\u003e\u0026nbsp;(5.15 \u0026ndash; 7.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e6.10\u0026nbsp;\u003cbr\u003e\u0026nbsp;(5.0 \u0026ndash; 7.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e6.20\u003cbr\u003e\u0026nbsp; (5.0 \u0026ndash; 6.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e7.03\u0026nbsp;\u003cbr\u003e\u0026nbsp;(6.18 \u0026ndash; 7.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003eH =18.09\u003csup\u003e*\u003cbr\u003e\u0026nbsp;\u003c/sup\u003ep\u0026lt;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eU = 6922.5\u003cbr\u003ep= 0.049\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSig.bet.grps\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" style=\"width: 427px;\"\u003e\n \u003cp\u003ep\u003csub\u003e1\u003c/sub\u003e=0.032\u003csup\u003e*\u003c/sup\u003e,p\u003csub\u003e2\u003c/sub\u003e=0.700,p\u003csub\u003e3\u003c/sub\u003e\u0026lt;0.001\u003csup\u003e*\u003c/sup\u003e,p\u003csub\u003e4\u003c/sub\u003e=0.117,p\u003csub\u003e5\u003c/sub\u003e=0.155,p\u003csub\u003e6\u003c/sub\u003e=0.002\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBASFI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e5.60\u0026nbsp;\u003cbr\u003e\u0026nbsp;(4.25 \u0026ndash; 7.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e5.45\u0026nbsp;\u003cbr\u003e\u0026nbsp;(3.60 \u0026ndash; 7.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e5.80\u003cbr\u003e\u0026nbsp; (4.80 \u0026ndash; 7.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e6.80\u003cbr\u003e\u0026nbsp; (5.40 \u0026ndash; 7.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e6.50\u0026nbsp;\u003cbr\u003e\u0026nbsp;(5.0 \u0026ndash; 7.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e7.0\u0026nbsp;\u003cbr\u003e\u0026nbsp;(5.90 \u0026ndash; 7.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003eH =19.779\u003csup\u003e*\u003cbr\u003e\u0026nbsp;\u003c/sup\u003ep\u0026lt;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eU =5928.0\u003csup\u003e*\u003c/sup\u003e\u003cbr\u003ep\u0026lt;0.001\u003csup\u003e*\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eASQoL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e11\u0026nbsp;\u003cbr\u003e\u0026nbsp;(5.50 \u0026ndash; 14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e10.0\u003cbr\u003e\u0026nbsp; (5.0 \u0026ndash; 13.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e12.0\u0026nbsp;\u003cbr\u003e\u0026nbsp;(9.0 \u0026ndash; 16.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e14.0\u0026nbsp;\u003cbr\u003e\u0026nbsp;(9.0 \u0026ndash; 16.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e12.0\u0026nbsp;\u003cbr\u003e\u0026nbsp;(9.0 \u0026ndash; 16.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e14.0\u003cbr\u003e\u0026nbsp; (10.0 \u0026ndash; 16.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003eH = 25.776\u003csup\u003e*\u003cbr\u003e\u0026nbsp;\u003c/sup\u003ep\u0026lt;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eU= 5732.5\u003csup\u003e*\u003cbr\u003e\u0026nbsp;\u003c/sup\u003ep\u0026lt;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eH: H for \u003cstrong\u003eKruskal Wallis test, \u0026nbsp; \u0026nbsp; \u0026nbsp;U\u003c/strong\u003e: \u003cstrong\u003eMann Whitney test,\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ec\u003csup\u003e2\u003c/sup\u003e\u003c/strong\u003e: \u003cstrong\u003eChi Square test, MC\u003c/strong\u003e:\u003cstrong\u003e\u0026nbsp;Monte Carlo test\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ep: p value for comparing between the four studied groups\u003c/p\u003e\n\u003cp\u003ep\u003csub\u003e0\u003c/sub\u003e: p value for comparing between \u003cstrong\u003eHLA-B27 Positive and negative\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ep\u003csub\u003e1\u003c/sub\u003e: p value for comparing between G1 and G2 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; , p\u003csub\u003e2\u003c/sub\u003e: p value for comparing between G1 and G3 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003ep\u003csub\u003e3\u003c/sub\u003e: p value for comparing between G1 and G4 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; , p\u003csub\u003e4\u003c/sub\u003e: p value for comparing between G2 and G3 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ep\u003csub\u003e5\u003c/sub\u003e: p value for comparing between G2 and G4 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;, p\u003csub\u003e6\u003c/sub\u003e: p value for comparing between G3 and G4\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e*: Statistically significant at p \u0026le; 0.05\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable (3): HLA-B27 and Disease Characteristics\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 258px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHLA-B27\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTest of Sig.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNegative\u003cbr\u003e\u0026nbsp;(n = 113)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePositive\u003cbr\u003e\u0026nbsp;(n = 143)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatterns of joint involvement\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eAxial\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e16.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e27.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e=\u003cbr\u003e3.940\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.047\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eAxial + Peripheral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e83.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e72.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEnthesitis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e31.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e46.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e=\u003cbr\u003e5.902\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.015\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e68.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e53.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDactylitis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e76.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e87.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e=\u003cbr\u003e5.569\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.018\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e23.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e12.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUveitis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e85.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e76.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e=\u003cbr\u003e\u0026nbsp;3.017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.082\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e15.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e23.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eESR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 126px;\"\u003e\n \u003cp\u003e28.10 \u0026plusmn; 18.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 132px;\"\u003e\n \u003cp\u003e29.49 \u0026plusmn; 20.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 84px;\"\u003e\n \u003cp\u003eU=\u003cbr\u003e\u0026nbsp;8041.500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.948\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eMedian (Min. \u0026ndash; Max.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 126px;\"\u003e\n \u003cp\u003e24.0 (3.0 \u0026ndash; 90.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 132px;\"\u003e\n \u003cp\u003e23.0 (3.0 \u0026ndash; 90.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCRP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 126px;\"\u003e\n \u003cp\u003e11.55 \u0026plusmn; 15.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 132px;\"\u003e\n \u003cp\u003e13.79 \u0026plusmn; 12.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 84px;\"\u003e\n \u003cp\u003eU=\u003cbr\u003e6075.50\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eMedian (Min. \u0026ndash; Max.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 126px;\"\u003e\n \u003cp\u003e5.90 (0.20 \u0026ndash; 68.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 132px;\"\u003e\n \u003cp\u003e11.30 (0.30 \u0026ndash; 68.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-9448653/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9448653/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective:\u003c/h2\u003e \u003cp\u003eTo assess the clinical features, disease activity, functional status, and quality of life in Egyptian patients with axial spondyloarthritis (axSpA), and to explore the influence of gender and HLA-B27 status on disease expression.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003eThis cross-sectional study included 256 patients fulfilling ASAS criteria for axSpA. Clinical data, HLA-B27 status, laboratory markers, imaging findings, and treatment regimens were recorded. Disease activity was measured using ASDAS-CRP and BASDAI, functional status with BASFI, spinal mobility with BASMI, and quality of life with ASQoL. Statistical analyses were performed to assess gender and HLA-B27-related differences.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eOf 256 patients (57.4% male), 55.9% were HLA-B27 positive and 70.3% had radiographic axSpA. The cohort demonstrated very high disease activity (mean ASDAS-CRP 4.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91), exceeding values reported in most international studies. Females showed more peripheral joint involvement and dactylitis, with higher BASDAI, BASFI, and ASQoL scores, indicating greater disease burden. HLA-B27 positive patients were more likely to have axial disease and elevated CRP levels, while HLA-B27 negative patients had higher rates of peripheral involvement, enthesitis, and dactylitis. HLA-B27 positivity was associated with better quality of life.\u003c/p\u003e\u003ch2\u003eConclusion:\u003c/h2\u003e \u003cp\u003eAxSpA shows marked variability influenced by gender and HLA-B27 status. Female patients experience more severe symptoms and functional limitations, warranting tailored, gender-sensitive care. HLA-B27 positivity correlates with axial involvement and more favorable outcomes, underscoring its clinical relevance. Comprehensive, individualized treatment approaches are essential to address both physical and psychosocial aspects of the disease.\u003c/p\u003e","manuscriptTitle":"Impact of Sex and HLA-B27 Positivity on Clinical Characteristics and Patient-Reported Outcomes in a Cohort of Egyptian Axial Spondyloarthritis Patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-11 08:15:40","doi":"10.21203/rs.3.rs-9448653/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"312315335181119735879726481683783215457","date":"2026-05-12T07:51:44+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-29T12:35:45+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-29T12:33:17+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-27T11:02:20+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-25T08:28:47+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Musculoskeletal Disorders","date":"2026-04-25T08:24:26+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"00005a4a-e23b-455d-9793-fe3d74ef9099","owner":[],"postedDate":"May 11th, 2026","published":true,"recentEditorialEvents":[{"type":"reviewerAgreed","content":"312315335181119735879726481683783215457","date":"2026-05-12T07:51:44+00:00","index":86,"fulltext":""},{"type":"reviewersInvited","content":"54","date":"2026-04-29T12:35:45+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-29T12:33:17+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-11T08:15:40+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-11 08:15:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9448653","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9448653","identity":"rs-9448653","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}