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Nicola Luigi Bragazzi, MD, PhD: Sex-Based Medicine in Psoriatic Arthritis

Nicola Luigi Bragazzi, MD, PhD, explains the importance of sex-based medicine in psoriatic arthritis and shares his advice for future studies.

Rheumatology Network interviewed Nicola Luigi Bragazzi, MD, PhD, to discuss his article “Sex-Based Medicine Meets Psoriatic Arthritis: Lessons Learned and to Learn.” Bragazzi is a postdoctoral fellow at both York University in Canada and University of Leeds in the United Kingdom.

Rheumatology Network: What prompted your team to study sex-based medicine in psoriatic arthritis (PsA)?

Nicola Luigi Bragazzi, MD, PhD: I have always been interested in sex and gender medicine and I have written different papers in the field. I think that sex and gender in the medical field is absolutely necessary if you want to provide personalized treatment and management of serious diseases. Psoriatic arthritis, specifically, is a topic which is often overlooked in literature and also in in practice.

RN: Why do you believe psoriatic arthritis is overlooked?

NB: Generally, sex and gender medicine is considered limited to fields like gynecology, obstetrics, and so on. In the entire field of rheumatology, there are not many studies adopting and a sex and gender perspective.

RN: What were the findings within your study?

NB: There are sex-specific differences concerning different aspects including epidemiology, the genetic background of the disease, the clinical and hydrological aspects, and of course, above all, the response to treatment and management. So, sex differences as well as the practical implications. The second finding was that for some aspects, there are contrasting results. For example, some studies found a higher rate among males, while other studies showed higher rates among females. But perhaps the most important findings were that axial involvement in spondylitis was more frequent among males and the response to treatments was poor among females, most notably in their response to biologics.

RN: What are some of the important implications for future clinical research and practice?

NB: The most practical implication is that more studies are needed. Findings should be stratified according to the sex and gender and we should study particular pharmacological treatments, especially for females because side effects are higher among females in general. If we consider randomized clinical trials, generally the recruitment of male subjects is higher. So, we have to involve more females in these clinical trials to stratify according to gender. Another suggestion for future studies is to evaluate the effect of hormone therapy in sex and gender among diverse populations, such as transgender patients. It’s important to include these populations in order to better shed a light on the mechanisms of action and impact of hormones on disease.

RN: Does your team plan on doing any further research on this topic?

NB: Yes, we are doing a longitudinal study analyzing the results and outcomes based on sex and gender regarding different risk factors. We are doing epidemiological studies at the University of Leeds with Professor Dennis McGonagle, who is very well known for his studies on enthesitis, to see if the rate of enthesitis it is more frequent among females or males.