EARLY MENOPAUSE PREDICTS A MILDER FORM OF RHEUMATOID ARTHRITIS #eular12

A new study presented at EULAR 2012, the Annual Congress of the European League Against Rheumatism, shows that early menopause predicts a milder form of rheumatoid arthritis (RA).

New insights on factors influencing RA are good news for sufferers of the chronic inflammatory disease that currently affects over 2 million women in Europe. i,ii The study, based on 134 incident RA cases, found that patients aged over 45 years with a history of early menopause were 50% less likely to develop severe RA (16% versus 35%) and more likely to develop a mild/moderate rheumatoid factor (RF) negative phenotype (58% versus 20%). There was no major difference in RA severity depending on oral contraceptive use or history of breast feeding. This study highlights that hormonal changes may influence pathways that are distinct from those leading to severe, progressive disease. Dr. Mitra Pikwer from Skåne University Hospital, Sweden, and lead study author commented: “We already know that hormonal factors may influence the risk of RA, but this is the first study we know of that investigates the impact of menopausal age on the severity of RA. This is an important breakthrough, both in helping us understand the impact that hormones may have on the development of this disease and potentially also in helping us predict the long-term prognosis for our patients.”

The study identified patients who answered a questionnaire in a community based health survey (conducted between 1991 and 1996) and later developed RA. Information on hormonal predictors including breastfeeding history, history of oral contraceptive use and menopausal age (early menopause ≤45 years or normal/late menopause > 45 years) was obtained via the questionnaire. By a structured review of the patients medical records, relevant information such as use of disease modifying anti-rheumatic drugs (DMARDs) including biological treatment, radiographic erosions, rheumatoid factor (RF) status as well as Health Assessment Questionnaire (HAQ*) data was collected. These variables were added to the SPSS TwoStep Cluster Analysis in order to reveal natural groupings of RA severity. RA is a chronic inflammatory disease with female predominance. Hormonal factors such as breastfeeding history, use of oral contraceptives and menopausal age have all been suggested to influence the risk of RA. As yet the underlying mechanisms and their impact on disease progression are unknown.

i Bevan S, Quadrello T, McGee R et al. Fit for work? Musculoskeletal disorders in the European workforce.

ii Englund M, Jöud A, Geborek P et al. Prevalence and incidence of rheumatoid arthritis in southern Sweden 2008 and their relation to prescribed biologics. Rheumatology 2010; 49: 1563-9.