Women with rheumatoid arthritis (RA) experience a worsening in the speed and degree of functional decline when they enter menopause, data from a large, observational study suggest.
The findings “indicate that menopause has a significant impact on the level and rate of functional decline in women with RA,” the study authors write.
A clinical relationship between hormonal status and RA disease activity has already been observed in female patients, Elizabeth Mollard, PhD, from the University of Nebraska Medical Center College of Nursing-Lincoln Division, and colleagues write in an article published online January 29 in Rheumatology. For example, RA symptoms subside during pregnancy, and early menopause is associated with a greater risk of developing RA compared with normal or late menopause.
Given these observations, the authors studied the relationship between menopause and functional status in women with RA. They used data from the National Data Bank for Rheumatic Diseases, which is composed of patient self-reports and is the largest such databank in the United States.
Participants in the National Data Bank for Rheumatic Diseases complete a survey on entry, and then follow-up questionnaires every 6 months. These include the Health Assessment Questionnaire (HAQ), which measures pain and disability patients experience while conducting ordinary activities such as dressing, eating, and walking, as well as medication adverse effects and costs related to their illness. Positive scores on the HAQ indicate worsening functional status and greater functional decline, whereas negative scores reflect less functional decline and better functional status.
To be eligible for this study, women had to have received an RA diagnosis before menopause and to have completed at least two questionnaires between 2003 and 2017. Of the 8189 patients who met the inclusion criteria, 2005 (24.5%) were premenopausal at enrollment, 611 (7.5%) entered menopause during the study, and 5573 (68.1%) were postmenopausal. The mean age of each group was 39.7 years (standard deviation [SD], 7.8), 50.7 years (SD, 3.4), and 61.8 years (SD, 9.8), respectively.
The authors performed univariate and multivariable analyses that accounted for potential confounding variables including age, income level, length of reproductive life, RA duration, and use of tobacco, hormone replacement therapy, and oral contraceptives.
They found that “women who were pre-menopausal had a better HAQ score by −0.50 (95% [confidence interval]: −0.55, −0.19) compared with women who were post-menopausal [with interaction term with age of 0.01 (0.00; 0.01)], indicating that pre-menopausal women had less functional decline than post-menopausal women.” Other factors associated with less functional decline included ever use of hormone replacement therapy, a history of at least one pregnancy, and longer duration of reproductive life.
The findings suggest that not only is menopause associated with greater functional decline among women with RA, but also, milder decline may be related to the greater hormonal exposure, implied by a longer reproductive life, the authors write. “Additional study on RA symptoms and functional status throughout the menstrual cycle and other hormonal life events are indicated in understanding hormonal involvement in RA disease status.”
Study limitations include the inability to establish a directional relationship between functional decline and menopausal status, or to account for all potential confounding variables. Also, the National Data Bank for Rheumatic Diseases database and the HAQ rely on patient self-reports, which may not necessarily match objective clinical measures.
Nevertheless, these findings “suggest that menopause is associated with worse functional decline in women with RA. Further study is needed to understand this relationship,” the authors conclude.
One author reports receiving grant funding from Pfizer and the Rheumatology Research Foundation. The remaining authors have disclosed no relevant financial relationships.
Rheumatology. Published online January 29, 2018. Abstract
For more news, join us on Facebook and Twitter
Tidak ada komentar:
Posting Komentar