Gender differences in health-related quality of life in axial spondyloarthritis, psoriatic arthritis and systemic sclerosis: a scoping review.

BACKGROUND: Axial spondyloarthritis (AxSpA), psoriatic arthritis (PsA) and systemic sclerosis (SSc) substantially affect health-related quality of life (HRQoL). Gender-related factors may influence health behaviours, coping and access to care. Yet, studies often do not distinguish sex from gender or specify how these variables are measured, limiting insight into gender as a multidimensional construct. OBJECTIVES: To map how gender is conceptualised and operationalised in HRQoL studies among patients with AxSpA, PsA and SSc, and to summarise HRQoL differences between binary sex/gender groups. METHODS: We searched PubMed, Web of Science, EMBASE, CINAHL and PsycINFO. Eligible studies were quantitative, examined sex, gender or sex/gender as a primary variable in relation to HRQoL in AxSpA, PsA or SSc and were published in English or Dutch. Two reviewers screened records and extracted data. RESULTS: We included 30 studies, most published since 2021. All operationalised sex/gender as a binary variable, most often reported as male/female or men/women, without clearly distinguishing biological sex from gender identity. None measured broader gender dimensions. Reported HRQoL differences therefore reflected binary sex/gender comparisons, rather than multidimensional gender analyses. Female/women groups generally had lower HRQoL than male/men groups, particularly in PsA and AxSpA. Evidence for SSc was limited to one study. CONCLUSIONS: Current HRQoL research in AxSpA and PsA and limited evidence in SSc, reflects binary sex/gender comparisons rather than multidimensional gender analyses. Mechanisms remain unclear because biological, psychosocial and gender-related constructs were not directly measured. Future studies should distinguish sex and gender more clearly and incorporate gender-related measures where appropriate.