Impact of early age at menopause on disease outcomes in postmenopausal women with rheumatoid arthritis: a large observational cohort study of Korean patients with rheumatoid arthritis

Abstract

ObjectivesTo assess the differences in clinical outcomes between patients with rheumatoid arthritis (RA) with early menopause (EM) (<45 years) and usual menopause (UM) (≥45 years) and to identify the impact of EM on longitudinal changes in RA activity and patient-reported outcomes (PROs).MethodsWe recruited 2878 postmenopausal women with RA from the Korean Observational Study Network for Arthritis. Patients were examined at baseline and for 5 consecutive years using the Simplified Disease Activity Index (SDAI), Health Assessment Questionnaire–Disability Index (HAQ-DI) and other PROs. Generalised estimating equation (GEE) analyses were performed among patients with a baseline SDAI of >11 to evaluate the impact of EM on longitudinal changes in RA activity and PROs.ResultsThe EM group (n=437) was younger than the UM group (n=2441), but the RA duration was similar between the two groups. The EM group was more educated and more likely to be seronegative at enrolment. Moreover, the EM group demonstrated higher disease activity and worse PROs for global assessment, fatigue, sleep disturbance and health-related quality of life (HRQoL) (all p<0.05) at baseline. The GEE model revealed that EM significantly influenced the rate of SDAI change (β=1.265, p=0.004) after adjusting for age, RA duration, biologics use and SDAI at baseline. The EM group was also significantly associated with increased HAQ-DI scores and decreased EQ-5D-utility values during the 5-year follow-up period.ConclusionPatients with RA and EM demonstrate higher disease activity and poorer HRQoL. Furthermore, EM significantly affects the longitudinal changes in disease activity and PROs in patients with RA.

Complex role of oestrogens in the risk and severity of rheumatoid arthritis in menopause

“…The study of Park et al adds important clinical aspects, supporting that reduced lifetime exposure to oestrogens and related low serum concentrations, as reported in EM, contribute to most of the severe disease outcomes and comorbidities in postmenopausal women with RA. 1 However, no data have been reported regarding the hormonal serum concentrations in EM and UM patients in the above-mentioned study.…”

“…In their original article, Park et al investigated the differences in terms of clinical outcomes between early menopause (EM) (<45 years) and usual menopause (UM) (≥45 years) in a large nationwide cohort of patients with rheumatoid arthritis (RA), highlighting the impact of EM on longitudinal changes in RA activity and patient-reported outcomes (PROs). 1 …”

“…Therefore, for the first time, the study investigated the association between age at menopause and clinical impact in patients with RA using validated disease activity indices and PROs during their follow-up. 1 …”

“…Analysing the results of the study of Park et al on disease outcomes in postmenopausal women affected by RA, we should consider that pregnancy, post partum and menopause are clinically relevant to enhance the risk of developing or worsening autoimmune rheumatic disease outcomes, being influenced by physiological changes in several hormones, including oestrogens (see table 1 ). 1 8 9 …”

“…In conclusion, in the study of Park et al , no significant differences were observed between menopausal groups regarding previous or current use of HRT, even if it was found employed more frequently in EM, as expected. 1 …”