Background/Purpose: Rheumatoid arthritis (RA) is an autoimmune disease which is predominant in female with female to male ration ranging between 2:1 to 3:1.  The peak incidence of RA in women coincides with the time of menopause. When there are diminished production of estrogen , progesterone and adrenal androgen.

Aim : To assess the effect of menopause early versus late on the functional status of rheumatoid arthritis patients

 Methods: this was retrospective study. Fifty patients with RA diagnosed according to 2010 American College of Rheumatology /European League Against Rheumatism classification criteria for RA from those have been treated at our outpatient clinic, provided that they had developed RA prior to the onset of menopause, all are non smoker and their records are available at our clinic archives. Twenty five of those patients had early onset menopause (<45years) constituted group I, while Group II was the remaining 25 patients with late onset menopause(≥45years).

All patients were subjected to history taking including history of the disease, drug history, gynecological history(age of menarche, age of menopause, parity), detailed musculoskeletal examination, current as well as previous Health Assessment Questionaire (HAQ) obtained from previous records that were taken prior to the onset of menopause to each patient. Current disease activity score 28(DAS28) was conducted to all patients.current Laboratory investigations including 1^st hour erythrocyte sedimentation rate (ESR), C-reactive protein

Results: The mean age for group I patients was 51.76±9.21, and for group II 55.24±4.28. No significant difference in between groups regarding demographic data (age of menarche, marriage status, parity, occupation. The mean disease duration for group I was 8.58±7.88 and for group II 9.57±9.75 (p=0.838). Regarding the use of disease modifying antirheumatic drugs(DMARDS) ; 21 patients of group I(84%) and 23 patients (92%) of group II used DMARDS. For group I, the  mean HAQ before menopause was 0.31±0.59 and that after menopause was 2.05±0.69(p=0.001). For group II the mean HAQ before menopause was 1.02±1.14 and that after menopause was 1.86±0.87(p=0.01). Before menopause, HAQ was significantly higher for group II (p=0.012) while after menopause there is no significant difference in between groups(p=0.496). After menopause, for those patients using DMARDS with both groups, the mean 1^st hour ESR was 60.95±32.02 for group I and 52.74±30.93 for group II(p=0.35), the mean C reactive protein   for group I was 64.62±72.75 and for groupII was 16.93±12 (p=0.238). The mean DAS for group I was 7.03±1.04, that of group II was 6.59±1.31(p=0.234)

Conclusion: Menopause significantly impairs the functional status of rheumatoid women whether this menopause is early or late. Early menopause tends to affect the disease activity more. Further studies with larger samples will help to document the impact of menopause on functional impairment as well as disease activity of rheumatoid arthritis

Study limitation: lack of previous laboratory studies and DAS28 prior to menopause limited the accuracy of results regarding menopause and disease activity.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/impact-of-menopause-on-functional-impairment-of-rheumatoid-arthritis-patients/