Reproductive factors linked to functional disability in women with RA
medwireNews: Postmenopausal women with rheumatoid arthritis (RA) may experience less favourable disability outcomes than premenopausal patients, Swiss researchers report.
Deshire Alpizar-Rodriguez (University Hospitals of Geneva) and colleagues demonstrated that the 1025 postmenopausal patients who were included in the Swiss Clinical Quality Management in Rheumatoid Arthritis register between 1996 and 2017 had significantly higher Health Assessment Questionnaire Disability Index (HAQ-DI) scores at baseline than their 624 premenopausal counterparts, with median scores of 0.8 versus 0.6 points.
And functional disability improved to a lesser extent over 5 years of follow-up among the postmenopausal compared with the premenopausal women, with decreases in median HAQ-DI scores of 0.03 versus 0.12 points, a significant difference after adjustment for factors including age, disease duration and biologic treatment.
“Because patients are enrolled into the registry by rheumatologists generally before starting their first effective antirheumatic therapy, patient-reported outcomes, such as HAQ, typically improve during the first years of follow-up”, explain Alpizar-Rodriguez and team.
The most commonly used treatments in both the pre- and postmenopausal groups were conventional DMARDs (82–86%), followed by biologics (41–43%) and glucocorticoids (17–18%), and a similar proportion of patients in both groups were using the different medications.
Postmenopausal women had significantly worse median baseline erosion scores than those in the premenopausal group (2.8 vs 1.6 points), but radiographic progression of RA was not significantly different between the two groups.
The researchers also identified an association between age at menopause and disability progression. Women who entered menopause before the age of 45 years experienced worsening in HAQ-DI score over the follow-up period (median increase=0.03 points), whereas those with an older age at menopause experienced an improvement (median decrease=0.05 points).
Together, these findings “suggest a less favourable evolution of functional disability in post-menopausal women”, write Alpizar-Rodriguez and colleagues in Rheumatology.
Moreover, they say that in the premenopausal group, those with at least one previous pregnancy “tended to have less structural joint damage over time” than nulliparous women. However, there was no such association among postmenopausal women.
Although the study had “a large sample size and a long follow-up time”, the investigators caution that it was limited by self-reporting of reproductive factors, and while statistically significant, the differences in disability progression between pre- and postmenopausal women “may not be clinically meaningful.”
Nonetheless, they believe that “women with RA during the post-menopausal period may justify a closer medical follow-up, particularly those with an early age at menopause, because of the increased risk of comorbidities and potentially less favourable functional evolution.”
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