Women with rheumatoid arthritis (RA) report a decline in physical function after menopause, possibly due to shifting hormone levels, according to a recent study in the journal Rheumatology.
The researchers, led by Elizabeth Mollard, PhD, an assistant professor and advanced nurse practitioner at the University of Nebraska Medical Center, in Lincoln, undertook the study because there are known associations between RA and female hormones, but the connections are poorly understood. For example, RA often goes into remission during pregnancy but flares after delivery. First-time symptoms of RA appear more frequently after pregnancy, too. And for reasons that may or may not be hormone-related, women get RA at three times the rate that men do and they tend to have more pain and disability than their male counterparts.
To better understand the relationship in women with RA between menopause and how well they can function, the researchers reviewed information on more than 8,000 women in the National Data Bank for Rheumatic Diseases (NDB) in Wichita, Kansas. About 2,000 participants were premenopausal, 611 were perimenopausal (transitioning to menopause) and more than 5,500 were postmenopausal. (The average ages of premenopausal, perimenopausal and postmenopausal women were 40, 51 and 62, respectively). All were diagnosed with RA before menopause.
Each woman had completed a survey called the Health Assessment Questionnaire (HAQ) as part of a larger survey sent out every six months. The HAQ measures how well a person can perform common activities of daily living like dressing, eating, walking and getting up and down from a chair. Each activity is rated on a 3-point scale, with 0 meaning “no problem” and 3 meaning “no can do.” To be included in the study, participants had to have completed at least two HAQs between 2003 and 2017.
After taking into account factors that might influence the results – such as income, age, exercise level, disease duration and severity and arthritis medications – the researchers found that overall, postmenopausal women scored a half point higher (meaning they had a worse outcome) on the HAQ than premenopausal women. The decline was less severe in women who had a longer reproductive life (early menstruation or late menopause), had ever been pregnant or had used hormone replacement therapy (HRT).
“Knowing the actual quantitative differences through menopause was important to show,” says senior study author Kaleb Michaud, PhD, associate professor in the division of rheumatology and immunology at the University of Nebraska Medical Center and co-director of the NDB. It was also important to show “how early versus late menopause can make a difference,” he adds.
Link Still Unclear
The study has some limitations. For example, it relies on self-reports by participants, which can often be unreliable. For example, a woman’s perception of her functional ability might be higher or lower than it really is, or it might differ from what functional tests show. Menopause status was also based on self-reports. And although the study shows a decline in function after menopause, it doesn’t prove menopause causes it.
But “just knowing that this effect exists can help the patient when having a conversation with their physicians,” says Michaud. “This may raise the importance of hormone changes on RA activity, though our study did not address this, we hope it will encourage future studies to do so.”
Mehret Birru Talabi, MD, an assistant clinical professor of rheumatology at the University of Pittsburgh, points out that women who don’t have RA also experience a decline in physical function after menopause, but no one is sure why. Dr. Birru Talabi, who wasn’t involved in the study, is an expert in menopause transition.
“Part of the decline in functioning could be caused by diminishing hormones, but more work is needed to clarify [this],” she says. “With that in mind, we have to be really careful before recommending hormone replacement therapies or other hormonal treatments to patients. This study provides another important data point, but we just don’t have enough knowledge to say definitively that hormonal treatments should be used among women with RA to improve or preserve physical functioning.”
Still, the study results are concerning, she says, “especially because some women with RA already struggle to complete the activities of daily living – whether menopausal or not.”
What You Can Do
That makes improving physical function as women age, particularly around the time of menopause, even more important.
Dr. Birru-Talabi says steps women can take “might include starting or upgrading an exercise program, making healthy eating choices, curbing postmenopausal weight gain, stopping smoking, reducing excess alcohol use, and finding ways to reduce stress and improve their overall quality of life.”
Author: Linda Rath
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