Reproductive history and postmenopausal rheumatoid arthritis among women 60 years or older

Beydoun, Hind A.; el-Amin, Rawan; McNeal, Malikah; Perry, Charleigh; Archer, David F.

doi:10.1097/gme.0b013e3182a14372

Cited by 37 publications

(27 citation statements)

References 18 publications

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“…Another study found that 25% of women with RA reported age at menopause as <45 years . Other studies have found that early menopause is associated with increased risk for RA . Based on this literature, it appears that a higher percentage of postmenopausal women with RA have had early menopause; however, we were unable to confirm this, as there is no control group in our study design.…”

Section: Discussionmentioning

confidence: 63%

“…Several studies looking at age at menopause and RA have supported that it may play a role in risk for RA as well as disease activity in established RA. Women with older age at menopause have been shown to have reduced risk of developing RA compared to those who had early age at menopause , while early age at menopause has been associated with increased risk of developing RA . In addition, one study found that patients who had early menopause were less likely to be rheumatoid factor (RF) positive or need biologic agent therapy than those with normal age at menopause .…”

Section: Introductionmentioning

confidence: 99%

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Effect of Age at Menopause on Disease Presentation in Early Rheumatoid Arthritis: Results From the Canadian Early Arthritis Cohort

Wong

Huang

Pope

et al. 2015

Arthritis Care & Research

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Objective. Studies suggest that hormonal states affect disease characteristics in women with rheumatoid arthritis (RA). This study investigated how age at menopause affects disease in women presenting with early RA. Methods. This was a cross-sectional study of postmenopausal women with early RA under age 65 years at time of enrollment in the Canadian Early Arthritis Cohort. RA-related disease characteristics in women who had early age at menopause (EM; age at menopause <45 years) were compared to those who had usual age at menopause (age at menopause ‡45 years). The t-test was applied to continuous variables and the chi-square test to categorical variables. Multivariate logistic regression analysis was used to adjust for age at menopause, smoking, and use of exogenous hormones. Results. A total of 534 women were included; 93 were in the EM group. The age at RA onset was similar between groups. The EM group had higher mean patient global and pain scores and was more likely to be rheumatoid factor (RF) positive and meet the 1987 American College of Rheumatology criteria for RA. Using multivariate logistic regression, the EM group was more likely to be RF positive (odds ratio 2.2 [95% confidence interval 1.3-3.8], P 5 0.005). Symptom duration, joint counts, Disease Activity Score in 28 joints, Health Assessment Questionnaire scores, and inflammatory markers did not differ between groups. Conclusion. These data suggest that early age at menopause, compared to usual age at menopause, is associated with seropositivity in women with early RA.

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Section: Discussionmentioning

confidence: 63%

Section: Introductionmentioning

confidence: 99%

Effect of Age at Menopause on Disease Presentation in Early Rheumatoid Arthritis: Results From the Canadian Early Arthritis Cohort

Wong

Huang

Pope

et al. 2015

Arthritis Care & Research

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“…Figure 1 shows the flowchart of literature inclusion and exclusion. We identified 47 publications for full-text evaluation, of which 30 publications were further excluded because they did not fulfill the inclusion criteria (ie, conference abstracts,34–42 meta-analyses/reviews,50–58 letters to editor/comments,59 cross-sectional studies,29,30 providing insufficient data,28 involving the same study population or overlapped data,8,31–33 involving family cases,13,17 reporting the relationship between noncontraceptive hormones and RA among perimenopausal and postmenopausal women,11 and using OCs users with less than one patient as reference9). Therefore, our meta-analysis was based on 17 publications, including 12 case-control and five cohort studies published between 1982 and 2010 4,7,10,12,14–16,18–27.…”

Section: Resultsmentioning

confidence: 99%

Meta-analysis of oral contraceptives and rheumatoid arthritis risk in women

Qi¹,

Xin²,

Guo³

et al. 2014

TCRM

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Background and objectivesEpidemiological investigations of the relationship between oral contraceptives and rheumatoid arthritis (RA) risk have reported controversial results. Therefore, a meta-analysis of case-control or cohort studies was performed to evaluate the role of oral contraceptives in relation to risk of developing RA.MethodsEligible studies were identified from databases PubMed and EMBASE by searching and reviewing references. Random effect models were utilized to summarize the relative risk (RR) estimates with 95% confidence intervals (CIs).ResultsA total of 12 case-control studies and five cohort studies were eligible for our analysis. No statistically significant association was observed between oral contraceptives and RA risk (RR=0.88, 95% CI=0.75–1.03). In the subgroup of geographic area, a decreased risk of borderline significance was observed for oral contraceptive users in European studies (RR=0.79, 95% CI=0.62–1.01), but this association did not emerge in the North American studies group (RR=0.99, 95% CI=0.81–1.21). No evidence for publication bias was detected (P for Egger’s test =0.231).ConclusionOur results of meta-analysis do not support the hypothesis of a protective effect of oral contraceptives on the risk for RA in women.

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“…Instead, there are consistent data supporting that estrogens have a protective effect in the clinical development of the disease. These include that early menopause is associated with the subsequent development of RA, most of the patients experience partial or complete remission during pregnancy but relapse during the postpartum period, and there is a reduction in the incidence of disease onset during pregnancy but the incidence increases in the postpartum [57,[59][60][61][62][63][64][65][66][67]. Interestingly, estrogens have both pro-and anti-inflammatory effects that may explain their paradox in RA pathogenesis.…”

Section: Hormonal Factorsmentioning

confidence: 99%

Individuals at risk of seropositive rheumatoid arthritis: the evolving story

Rantapää-Dahlqvist

Andrade

2019

J Intern Med

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The aetiology of the autoimmune disease rheumatoid arthritis (RA) involves a complex interplay between genetic and environmental factors that initiate many years before the onset of clinical symptoms. These interactions likely include both protective and susceptibility factors which together determine the risk of developing RA. More than 100 susceptibility loci have been linked to RA. The strongest association is with HLA‐DRB1 alleles encoding antigen presenting molecules containing a unique sequence in the peptide‐binding grove called the ‘shared epitope’. Female sex, infections during childhood, lifestyle habits (e.g. smoking and diet) and distinct microbial agents, amongst many others, are interacting risk factors thought to contribute to RA pathogenesis by dysregulating the immune system in individuals with genetic susceptibility. Interestingly, patients with RA develop autoantibodies many years before the clinical onset of disease, providing strong evidence that the lack of tolerance to arthritogenic antigens is amongst the earliest events in the initiation of seropositive RA. Here, we will discuss the clinical and mechanistic evidence surrounding the role of different environmental and genetic factors in the phases leading to the production of autoantibodies and the initiation of symptomatic RA. Understanding this complexity is critical in order to develop tools to identify drivers of disease initiation and propagation and to develop preventive therapeutics.

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Reproductive history and postmenopausal rheumatoid arthritis among women 60 years or older

Cited by 37 publications

References 18 publications

Effect of Age at Menopause on Disease Presentation in Early Rheumatoid Arthritis: Results From the Canadian Early Arthritis Cohort

Effect of Age at Menopause on Disease Presentation in Early Rheumatoid Arthritis: Results From the Canadian Early Arthritis Cohort

Meta-analysis of oral contraceptives and rheumatoid arthritis risk in women

Individuals at risk of seropositive rheumatoid arthritis: the evolving story

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