Abstract Background/Aims Early identification and diagnosis of inflammatory arthritis is critical to improving patient outcomes. Primary care clinicians, particularly those working in musculoskeletal (MSK) settings, play a pivotal role in recognising early signs and facilitating timely referral. Sex-related differences in disease presentation and progression may contribute to diagnostic delays, particularly in female patients. We aimed to explore sex-related differences in the early clinical manifestations of inflammatory arthritis—specifically rheumatoid arthritis (RA), psoriatic arthritis (PsA), and axial spondyloarthritis (AxSpA)—and to highlight key signs that primary care clinicians should recognise to support early diagnosis. Methods A narrative literature review was conducted using peer-reviewed sources from databases including PubMed, Scopus, and MEDLINE. Studies were selected based on relevance to early-stage inflammatory arthritis, sex/gender differences, and applicability to primary care. The review focused on clinical presentation, diagnostic blood tests, radiographic findings, and early treatment response. Results Across all three conditions, females consistently experienced longer time to diagnosis, higher disease activity scores, and poorer functional outcomes. In PsA, women reported more tender joints, fatigue, and enthesitis, while men showed greater axial involvement and radiographic damage. In RA, females had higher DAS28 and HAQ scores, and were more likely to present with fibromyalgia and depression. In AxSpA, women experienced longer diagnostic delays, more peripheral and cervical spine involvement, and poorer response to TNF inhibitors. Differences in inflammatory markers (CRP, ESR) and HLA-B27 positivity were also observed between sexes. Conclusion Sex-related differences in inflammatory arthritis significantly impact diagnosis, disease burden, and treatment outcomes. Primary care clinicians should be aware of these variations to reduce diagnostic delays and tailor management strategies. Greater awareness and integration of gender-specific insights into clinical practice can enhance early identification and improve long-term outcomes for patients with inflammatory arthritis. Full paper reference: Lewis T, Gregory WJ. Identifying and Diagnosing Inflammatory Arthritis: A Narrative Literature Review of Sex-Related Differences. Rheumato. 2025; 5(3):12. https://doi.org/10.3390/rheumato5030012 Disclosure T. Lewis: None. W.J. Gregory: None.
Lewis et al. (Wed,) studied this question.