Early Menopause Linked to Milder Rheumatoid Arthritis

Kate Johnson

June 08, 2012

June 8, 2012 (Berlin, Germany) — Although early menopause increases the risk of developing rheumatoid arthritis (RA), new research suggests it might be a milder form of the disease, researchers reported here at the European League Against Rheumatism Congress 2012.

"Rheumatoid arthritis is a heterogenous disease with different phenotypes," said Mitra Pikwer, MD, from Skåne University Hospital in Malmö, Sweden, during a press conference.

The milder form of RA associated with early menopause might be unrelated to the more severe forms seen in the general population, Dr. Pikwer told Medscape Medical News in an interview. "The risk factors for the severe type of RA are more genetic — or smoking. It may be different with early menopause," she explained.

The findings offer insight into how to manage patients who develop RA after early menopause, said Christopher Buckley, MD, PhD, professor of rheumatology at the University of Birmingham, United Kingdom, and chair of the EULAR Abstract Selection Committee.

"We know that early menopause is associated with many autoimmune diseases, including RA, but it wasn't clear that it was a milder form," he said in an interview with Medscape Medical News.

"What this study suggests is that we should be thinking not just about the diagnosis of RA, but which type. Maybe it means they'll have milder disease and we need not worry about biologics," he noted. "Then it comes down to whether we would want to advise hormone replacement therapy or not."

The jury is still out on whether hormone replacement therapy might worsen RA, but it is a consideration, he cautioned.

The study involved 134 incident RA cases identified from 4 different registers. Mean age at RA diagnosis was 63.4 years, said Dr. Pikwer.

In this cohort, 25 women reported a history of early menopause, defined as occurring at 45 years of age or earlier.

Ten years after their RA diagnosis, women who had early menopause were less likely to have severe RA, with radiologic evidence of erosions, and less likely to require biologic therapy than women with normal menopause (16% vs 35%).

Women with early menopause were also more likely to have a mild/moderate rheumatoid factor (RF)-negative phenotype (58% vs 20%).

After 5 years, mean Health Assessment Questionnaire (HAQ) score was 1.17 in women with severe RA, 0.74 in women with RF-positive disease, and 0.88 in women with RF-negative RA.

Mean HAQ scores were significantly better in women with early than with normal menopause, both at diagnosis (0.50 vs 0.96) and 10 years later (0.67 vs 0.98), she said.

Disease severity was not linked to history of oral contraceptive use or breastfeeding.

"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," said Dr. Pikwer. "This is an important breakthrough, both in helping us understand the impact that hormones can have on the development of the disease and in helping us predict the long-term prognosis for our patients."

Dr. Pikwer and Dr. Buckley have disclosed no relevant financial relationships.

European League Against Rheumatism (EULAR) Congress 2012: Abstract FRI0087. Presented June 8, 2012.

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