Early menopause and severity of rheumatoid arthritis in women older than 45 years

Mitra Pikwer, Jan-Åke Nilsson, Ulf Bergström, Lennart TH Jacobsson, Carl Turesson

ABSTRACT: INTRODUCTION: We aimed to investigate whether recognized hormonal predictors of rheumatoid arthritis (RA) also influence the severity of RA. METHODS: One hundred thirty-four incident RA cases identified by four different local and national registers, who had participated in a community-based health survey between 1991 and 1996, were included. By a retrospective structured review of the medical records, information on the use of disease-modifying antirheumatic drugs (DMARDs), erosions on radiographs, rheumatoid factor (RF) status, and disability measured by using the health assessment questionnaire (HAQ) were collected. The variables were added to the SPSS TwoStep Cluster Analysis to reveal natural groupings of RA severity. Known hormonal predictors analyzed were breastfeeding history, history of oral contraceptive (OC) use, and menopausal age. RESULTS: The mean age at RA diagnosis was 63.4 years; 72% were RF positive, and 28% had received biological treatment. Three clusters were identified, one with severe RA, one with mild/moderate RF-positive RA, and one with mild/moderate RF-negative RA. A significant difference (P = 0.005) was found in the distribution of clusters between patients with a history of early menopause compared with those with menopause after 45 years, with a higher proportion with mild/moderate RF-negative RA in the early-menopause subset. No major difference in severity of the disease was noted depending on OC use or history of breastfeeding. CONCLUSIONS: Early menopause was associated with a milder form of RA. Hormonal changes may influence pathways that are distinct from those leading to severe, progressive disease.