Menopause associated with physical decline in women with RA
medwireNews: Postmenopausal women with rheumatoid arthritis (RA) may experience a greater decline in physical functioning than their premenopausal counterparts, results of a US study suggest.
Kaleb Michaud (University of Nebraska Medical Center, Omaha) and colleagues carried out a nationwide observational study of 8189 women who developed RA prior to menopause. More than two-thirds (68.1%) of participants were postmenopausal at baseline, whereas a quarter (24.5%) were premenopausal and the remainder reached menopause during the study.
Participants who had experienced menopause were significantly older than those who had not, with mean ages of 62.3, 50.7, and 39.7 years in the postmenopausal, menopausal, and premenopausal groups, respectively. Patients in the three groups were followed up for a corresponding mean of 5.3, 7.9, and 3.1 years.
Using a model that accounted for factors including age, RA treatment, and smoking, the researchers found that postmenopausal women experienced a significantly greater degree of functional decline as measured by the Health Assessment Questionnaire (HAQ) than those who had not yet reached menopause.
And the strength of the association between menopause and worsening physical functioning was modified by age, report Michaud and colleagues in Rheumatology.
The results of the statistical model translate into a worsening of HAQ scores for post- versus premenopausal women of 0.18 points for a 40-year-old, 0.11 points for a 45-year-old, and 0.04 points for a 50-year-old, they explain.
Furthermore, prior pregnancy, use of hormone replacement therapy, and a higher number of reproductive years were associated with a lesser degree of functional decline.
Although their model accounted for a number of variables, the researchers caution that unmeasured confounders may have influenced their results, and they note that their study was not able to determine a causal relationship between menopause and declining functional status.
“Further study is needed as to why women with rheumatoid arthritis are suffering a greater decline in function after menopause,” said study author Elizabeth Mollard in a press release.
“Not only is this decline causing suffering for women, it is costly to both individuals and the healthcare system as a whole,” she added.
“Research is specifically needed on the mechanism connecting these variables with the eventual goal of identifying interventions that can maintain or improve function in postmenopausal women with rheumatoid arthritis.”
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