The influence of sex hormones on musculoskeletal pain and osteoarthritis

Gulati, Malvika; Dursun, Eren; Vincent, Katy; Watt, Fiona E.

doi:10.1016/s2665-9913(23)00060-7

Cited by 12 publications

(9 citation statements)

References 99 publications

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“…Similarly, the role of feasibility [ 32 ], proof-of-concept [ 33 ] or experimental medicine studies to aid definitive effectiveness trial design (or hybrid effectiveness and implementation designs [ 34 ]) to reduce the ‘evidence to practice gap’ were not explored. To overcome the disproportionate impact of knee OA experienced by some social groups it will be important to better understand the role of social determinants of health, including sex and gender, as they relate to risk and outcomes for knee joint injury [ 35 , 36 ] and PTOA [ 37 ] so that targeted interventions can be developed. Other important topics that did not garner much detailed discussion were novel imaging, biomechanical or molecular-based assessments, either to identify trial target populations or as early (surrogate) outcomes.…”

Section: Discussionmentioning

confidence: 99%

Toward designing human intervention studies to prevent osteoarthritis after knee injury: A report from an interdisciplinary OARSI 2023 workshop

Whittaker,

Kalsoum,

Bilzon

et al. 2024

Osteoarthritis and Cartilage Open

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Section: Discussionmentioning

confidence: 99%

Toward designing human intervention studies to prevent osteoarthritis after knee injury: A report from an interdisciplinary OARSI 2023 workshop

Whittaker,

Kalsoum,

Bilzon

et al. 2024

Osteoarthritis and Cartilage Open

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“…Some reports from historic cohorts which have collected this information tend to focus on hand radiographic change rather than hand symptoms ( 23 ). Explanations for our findings could include menopause influencing disease susceptibility/incidence, magnifying the symptoms or severity of prevalent disease, including other related factors that enhance pain (e.g., sleep disturbance, mood) ( 21 ). It is important to emphasise that there does not appear to be a temporal relationship with menopause for all women with the condition, but rather in a substantial subgroup (3 in 5 of those studied): it is not possible to say from this study if these two subgroups clinically vary from each other in any other regard or be otherwise differentiated, which would be an important question for onwards research.…”

Section: Discussionmentioning

confidence: 99%

“…In a recent feasibility RCT of a form of HRT, more women in the active arm developed worse symptoms than those on placebo on tapering the study medication over a 4 week period, supporting this notion of symptomatic flare on estrogen withdrawal ( 27 ). A recent review highlighted that improved advice to the subgroup of women with osteoarthritis stopping HRT could have potential practical therapeutic relevance ( 21 ). Future studies might investigate the relative severity and duration of hand symptoms in previous, current and never users of HRT.…”

Section: Discussionmentioning

confidence: 99%

“…However several epidemiological studies examining the use of estrogen-containing HRT and its association with hand pain report conflicting findings ( 18 – 20 ). These studies are likely limited by substantial residual confounding (given that pain may be a reason to seek HRT prescription) and lack of validation cohorts ( 21 ). HRT use has been reported to have a significant protective effect on knee OA in Framingham cohort women (OR 0.31; 95% CI 0.11, 0.93) ( 22 ) and also in the Chingford cohort in the UK, where a weaker effect on hand joints was seen ( 23 ).…”

Section: Introductionmentioning

confidence: 99%

“…A systematic review found evidence for a protective effect of exogenous estrogen on hip OA ( 26 ). However there are very few randomized controlled trials (RCTs) testing the effects of estrogen-containing therapies in women included for MSK painful conditions ( 21 ). Only one study has been in symptomatic hand OA to our knowledge, which was a feasibility study so not designed to test efficacy ( 27 ).…”

Section: Introductionmentioning

confidence: 99%

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Could sex-specific subtypes of hand osteoarthritis exist? A retrospective study in women presenting to secondary care

Gulati,

Brewer,

Judge

et al. 2024

Front. Pain Res.

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IntroductionHand osteoarthritis is more common in women, and its risk increases around the time of the menopause. We set out to describe the timing between menopause and the onset of symptomatic hand osteoarthritis (OA), and associations with the use of hormone replacement therapy (HRT) or its discontinuation, describing any identifiable subgroups of women.MethodsRetrospective healthcare-records study of sequential women referred to a specialist hand OA clinic, 2007–2015. Confirmation of hand OA diagnosis was by clinican, by accepted criteria. Demographics and clinical variables were from healthcare-records, recorded by standardised proforma. Outcomes of interest were reported age of onset of hand symptoms, reported age at final menstrual period (FMP), time from FMP to reported onset of hand symptoms and time from cessation of HRT to reported onset of hand symptoms. Exposure categories for systemic HRT use were never users, current users, previous users. Analysis of Variance compared groups; linear regression analysed associations of exposure with outcome.Results82/92(89%) of eligible women were post-menopausal, mean age at FMP 49.9 years (SD5.4). In these post-menopausal women, median time from FMP to hand symptom onset was 3 years. 48/82 (59%) developed hand symptoms within the defined peri-menopausal period (FMP ± 4 years), whilst some women developed their symptoms before or after (range −25, 30 years). In women who discontinued HRT prior to symptom onset, the median time from HRT cessation to onset of hand symptoms was 6 months. Past HRT users were older at hand symptom onset than women who had not taken HRT [coeff.4.7 years (0.92, 8.39); P = 0.015].ConclusionsThis study adds to evidence associating the menopause/sex hormone deficiency with hand OA symptom onset in a sizeable subgroup of women (but not all). HRT use/cessation appears to influence the timing of onset of hand OA symptoms. It is not possible to interpret from this type of study whether sex hormone deficiency is causative of disease or modulates its symptoms. It is also not possible to judge whether painful hand osteoarthritis in post-menopausal women is a subtype of disease. Further investigation is indicated of sex-specific subtypes and potential for personalised medicine for post-menopausal women with hand osteoarthritis, as a clearly definable high-risk subgroup.

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Rheumatoid neutrophilic dermatitis: A case report and review of the literature

Scotti,

Misciali,

Merli

et al. 2024

JEADV Clinical Practice

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Rheumatoid neutrophilic dermatitis (RND) is a dermatological condition typically associated with rheumatoid arthritis (RA). The low prevalence of RND and the wide spectrum of its possible clinical appearances make the diagnosis challenging. Current literature is still lacking a comprehensive overview of this rare cutaneous disorder. The aim of this review is to summarize data from the existing literature on RND, focusing on its epidemiology, clinical manifestations, histopathology and treatment. Hence, a comprehensive literature search of case reports and series was made, starting from a Medline (via PubMed) and Scopus databases. We also included in the analysis one patient attending to our dermatology department and diagnosed with RND. Overall, 54 cases of RND were identified. The majority of patients were female (72.3%) with a median (IQR) age at the time of diagnosis of 58 (65‐45) years. RND followed the onset of RA in 87% of patients with an average (SD) latency time of approximately 10 (8.9) years. In 1 (1.8%) case the dermatitis preceded the appearance of joint symptoms, while in three (5.5%) cases it occurred concomitantly with them. Seropositive RA was the major associated form (76.5%). Clinically, asymptomatic papules (31%), nodules (15.1%) and/or plaques (13.5%) distributed bilaterally on extremities were most frequently described. Notably, females were more prone to develop a painful dermatitis (84.6%) compared to males. The vesicobullous (12.7%) and pustular (9.2%) clinical subtypes were the most demonstrative in contrast to the urticarial skin manifestations and the potential figurative/annular distribution of the lesions. Spontaneous resolution of RND was rare (5.5%). Systemic treatments, mainly represented by steroids and anti‐neutrophilic agents (dapsone, colchicine), were consistently required.

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The influence of sex hormones on musculoskeletal pain and osteoarthritis

Cited by 12 publications

References 99 publications

Toward designing human intervention studies to prevent osteoarthritis after knee injury: A report from an interdisciplinary OARSI 2023 workshop

Toward designing human intervention studies to prevent osteoarthritis after knee injury: A report from an interdisciplinary OARSI 2023 workshop

Could sex-specific subtypes of hand osteoarthritis exist? A retrospective study in women presenting to secondary care

Rheumatoid neutrophilic dermatitis: A case report and review of the literature

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