Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose: Rheumatoid arthritis (RA) preferentially affects women and studies suggest that various hormonal and reproductive factors may affect disease onset and severity. This study assessed how age at menopause affects disease presentation in post-menopausal women with early RA and explored the effects of hormone use.
Methods : Post-menopausal women from the Canadian early ArThritis CoHort (CATCH) under age 65 at time of enrollment were included. Early age at menopause (EM) was defined as age at menopause < 45; usual age at menopause (UM) was defined as age at menopause >/=45. The Wilcoxon rank sum test was applied to continuous variables and Chi-square test to categorical variables. Multivariate logistic regression analysis was used to adjust for age, smoking, education, and use of exogenous hormones.
Results : 534 women met inclusion criteria (see Table 1). The EM group was more likely to report current use of hormone replacement therapy (HRT) and had higher mean patient global scores and pain scores. The EM group was more likely to meet 1987 criteria for RA and have positive serologies for RF and ACPA. There was a non-significant trend for women to have more erosions in the EM group. There was no difference in DAS28. Multivariate logistic regression analysis showed that the EM group was more likely to be RF positive (OR 2.1, CI 1.2-3.6, p=0.01) and current HRT users were less likely to be RF positive (OR 0.5, CI 0.2-0.8, p=0.01). Current smokers were more likely to be RF positive (OR 1.6, CI 1.0-2.6, p=0.03) and ACPA positive (OR 2.5, CI 1.5-4.3, p=0.001). At the time of analysis, 35% of subjects did not have ACPA data available. After confirming that missing data had occurred at random, multiple imputation analysis was used and showed that the EM group was also more likely to be ACPA positive (OR 1.8, CI 1.1-2.9, p=0.03). Sensitivity analysis removing current hormone therapy users did not change these findings.
Conclusion: These data suggest that EM compared to UM is associated with different features at disease presentation in early RA, most notably in RF and ACPA positivity. Further research is needed to better understand how changes in hormonal states and exposure to exogenous hormone influence disease in women with rheumatoid arthritis.
Table 1: Baseline Characteristics
|
|
All Post-Menopausal Women (n=534)
|
Age at Menopause <45 (N=93)
|
Age at Menopause ≥45 (N=441)
|
P-value
|
|
Age at Study Entry |
55.5 ± 5.3 |
55.3 ± 6.0 |
55.5 ± 5.2 |
0.98 |
|
Age at Menopause
|
49.4 ± 6.5
|
38.5 ± 6.5
|
51.7 ± 3.5
|
0.001
|
|
CRP, mg/l |
1.3 ± 1.6 |
1.3 ± 1.6
|
1.3 ± 1.6
|
0.95
|
|
DAS28
|
5.0 ± 1.5
|
5.0 ± 1.5
|
5.0 ± 1.5
|
0.76
|
|
ESR, mm/h
|
28.5 ± 24.6
|
27.6 ± 24.0
|
28.7 ± 24.7
|
0.74
|
|
Patient global
|
5.9 ± 2.8
|
6.6 ± 2.9
|
5.8 ± 2.8
|
0.01
|
|
Pain
|
5.8 ± 2.6
|
6.5 ± 2.7
|
5.6 ± 2.6
|
0.002
|
|
Education ≥ High school
|
264 (49.4%)
|
31 (33.3%)
|
233 (52.8%)
|
0.001
|
|
Currently Employed |
340 (63.7%) |
57 (61.3%) |
283 (64.2%) |
0.599 |
|
Current Smoking
|
123 (23.0%)
|
31 (33.3%)
|
92 (20.9%)
|
0.01
|
|
Current Use of HRT
|
55 (10.6%)
|
19 (21.1%)
|
36 (8.4%)
|
<0.0001
|
|
Current Use of OCP
|
4 (0.8%)
|
1 (1.1%)
|
3 (0.7%)
|
<0.0001
|
|
Meeting 1987 ACR
|
337 (65.1%)
|
66 (75.0%)
|
271 (63.0%)
|
0.032
|
|
Meeting 2010 ACR |
428 (80.2%) |
77 (82.8%) |
351 (79.6%) |
0.481 |
|
Erosion positive |
106 (24.8%) |
22/71 (31.0%) |
84/356 (23.6%) |
0.188 |
|
RF positive
|
284 (57.7%)
|
58 (71.6%)
|
226 (55.0%)
|
0.01
|
|
ACPA positive
|
175 (48.8%)
|
34/56 (60.7%)
|
141/303 (46.5%)
|
0.05
|
Disclosure:
L. Wong,
None;
W. T. Huang,
None;
J. Xiong,
None;
G. Boire,
None;
B. Haraoui,
Amgen, Abbott, Bristol-Myers Squibb, Pfizer, Roche, UCB,
2,
Amgen, Abbott, Bristol-Myers Squibb, Pfizer, Roche, UCB,
8,
Amgen, Abbott, Bristol-Myers Squibb, Pfizer, Roche, UCB,
9;
J. E. Pope,
None;
J. C. Thorne,
None;
C. A. Hitchon,
None;
D. Tin,
None;
E. Keystone,
AstraZeneca,
2,
Abbott Laboratories,
2,
Amgen,
2,
Baylis Medical,
2,
Bristol-Myers Squibb,
2,
Hoffmann-La Roche, Inc.,
2,
Janssen Pharmaceutica Product, L.P.,
2,
Lilly Pharmaceuticals,
2,
Novartis Pharmaceutical Corporation,
2,
Pfizer Inc,
2,
Sanofi-Aventis Pharmaceutical,
2,
UCB,
2,
Abbott Laboratories,
5,
AstraZeneca,
5,
Biotest,
5,
Bristol-Myers Squibb,
5,
Hoffmann-La Roche, Inc.,
5,
Genentech and Biogen IDEC Inc.,
5,
Jannsen Inc,,
5,
Lilly Pharmaceuticals,
5,
Merck Pharmaceuticals,
5,
Nycomed,
5,
Pfizer Inc,
5,
UCB,
5,
Abbott Laboratories,
8,
AstraZeneca,
8,
Bristol-Myers Squibb,
8,
Hoffmann-La Roche, Inc.,
8,
Janssen Inc,
8,
Pfizer Inc,
8,
UCB,
8,
Amgen,
8;
V. P. Bykerk,
AMGEN, Antares, Astellas, Augurex, BMS, Genentech, Pfizer, Roche, UCB,
9,
Amgen Canada Inc., Pfizer Canada Inc., Hoffmann-LaRoche Ltd., UCB Canada Inc., Bristol-Myers Squibb Canada Co., AbbVie Corporation (formerly Abbott Laboratories Ltd.), and Janssen Biotech Inc. (a wholly owned subsidiary of Johnson & Johnson Inc.).,
2.
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