In this episode of RheumaCast, we explore new data from the international PROOF cohort on sex-specific differences in achieving disease control in axial spondyloarthritis (axSpA). The authors present compelling evidence that women with non-radiographic axSpA (nr-axSpA) are significantly less likely than men to reach low disease activity or inactive disease—despite similar treatment approaches and TNFi use.

What’s behind this disparity? We discuss potential contributors, including nociplastic pain mechanisms, mechanical mimics like osteitis condensans ilii, and sex-specific differences in sacroiliac joint anatomy. The findings highlight the urgent need for accurate diagnosis and a nuanced approach to treatment in women with axSpA—especially in the non-radiographic stage.

This episode is based on the publication: Poddubnyy D, et al. Rheumatology 2025; doi:10.1093/rheumatology/keaf447 and developed with NotebookLM.