Clinical features of rheumatoid arthritis in women depending on the timing and causes of menopause

Introduction. Rheumatoid arthritis (RA) is a disease characterized by epidemiological sexual dimorphism (affecting predominantly women). For many of women, the onset of the disease occurs around menopause, making it important to analyze the relationship between RA and estrogen deficiency.

Aim. To study the clinical features of RA in women depending on the age of menopause.

Materials and methods. A retrospective study of 246 postmenopausal women with an established diagnosis of RA in postmenopause was conducted. Patients were divided into subgroups depending on the age of menopause: early (before 45 years, n = 71) and timely menopause (≥45 years, n = 175), a comparison of quantitative and qualitative indicators was made between the subgroups. In the subgroup with early menopause, a division was made depending on the natural (n = 46) or surgical cause (n = 25) of its onset, followed by an intergroup comparison.

Results. Women with early menopause were comparable with the group with timely onset of menopause in terms of the main clinical and laboratory parameters characterizing RA. Women with natural early menopause, compared with early surgical menopause, were characterized by significantly higher levels of C-reactive protein (6.45 [3.35; 22.33] mg/L vs. 3.20 [1.70; 10.90] mg/L; p = 0.03) and ESR (28.50 [16.50; 58.00] mm/h vs. 16.00 [11.00; 29.00] mm/h; p = 0.021), as well as trends toward higher DAS28 activity (p = 0.06), more swollen joints (4.50 [2.25; 8.00] vs. 3.00 [1.00; 6.00]; p = 0.089), and a higher incidence of erosive arthritis (78.3% vs. 56.0%; p = 0.077). On the other hand, early surgical menopause was associated with a higher incidence of cardiovascular disease and hypertension (72.0% versus 34.8%; p = 0.003), as well as higher fasting glucose levels (5.49 [4.88; 5.79] mmol/l versus 5.00 [4.79; 5.40] mmol/l; p = 0.03) compared to women with early natural menopause.

Conclusions. The age of menopause in our sample did not have a significant effect on the clinical course of RA, but women with early natural menopause had higher rates reflecting the inflammatory activity of RA, and women with early surgical menopause more often suffered from metabolic disorders.

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