Early menopause can predict a milder form of rheumatoid arthritis and might influence paths that are distinct from those leading to more severe disease, researchers reported at the annual Congress of the European League Against Rheumatism in Berlin.
The Swedish, retrospective study included 134 patients who developed rheumatoid arthritis (RA) after participating as healthy volunteers in a survey from 1991 to 1996. The median duration from survey enrollment to RA diagnosis was 5.5 years, and the patients were aged 45 to 73 years at baseline. The mean age of the patients at diagnosis was 63.4 years, with 72% of patients being rheumatoid factor (RF) positive and 28% receiving biological treatment.
Three clusters were identified: patients with severe RA, patients with mild/moderate RF-positive RA, and patients with mild/moderate RF-negative RA. In the severe RA group, all patients had received biological treatment, 89% were RF positive, 85% had radiographic erosions and the mean Health Assessment Questionnaire (HAQ) score after 5 years was 1.17. In the mild/moderate RF-positive and -negative clusters, no one had received biologics, 56% and 52% had erosions, respectively, and mean HAQ scores after 5 years were 0.74 and 0.88, respectively.
There was a significant difference (P=.005) in the clusters between patients with early menopause (aged 45 years and younger) and those with normal or late menopause (older than age 45). Patients reaching early menopause were about 50% less likely to develop severe RA (16% vs. 35%) and more likely to develop a mild/moderate RF negative phenotype (58% vs. 20%). No major difference in RA severity was found between women who used oral contraceptives or breast-fed their children.
“This is the first study we know of that investigates the impact of menopausal age on the severity of RA,” researchers said. “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.”
For more information:
Pikwer M. #FRI0087: Early Menopause Predicts a Mild Type of Rheumatoid Arthritis. Presented at: the 2012 Annual Congress of European League Against Rheumatism, June 6-9, Berlin.