Patients with later menarche, earlier menopause have higher risk for rheumatoid arthritis
Click Here to Manage Email Alerts
Key takeaways:
- A study of UK Biobank data suggests that women with late menarche and early menopause demonstrate a higher risk for RA.
- Other risk factors were fewer than 33 reproductive years, hysterectomy and oophorectomy.
Menarche after the age of 14 years, or going through menopause before 45 years of age, are among the hormonal and reproductive factors that increase the risk for rheumatoid arthritis, according to data published in RMD Open.
“Female reproductive features, such as puberty, pregnancy, childbirth, menopause, breastfeeding, and exogenous exposure to hormone levels (hormone replacement therapy (HRT) or oral contraceptives) may influence the hormonal environment,” Ling-Qiong Jiang of Anhui Medical University, in China, and colleagues wrote. “For example, Jethwa et al reported reduced RA disease activity in pregnancy and a flare in the postpartum period, while Bengtsson et al reported peak incidence of the disease at menopause.
“While there is a wealth of literature linking hormonal and reproductive factors to an increased risk of RA, female-specific hormonal and reproductive factors and the gender differences in RA present a burgeoning research path that, to our understanding, has not been entirely explored,” they added.
To explore the link between hormonal and reproductive factors and the risk for RA, Jiang and colleagues analyzed U.K. Biobank data from 223,526 women (mean [SD] age = 56.2 [8.02] years). Among these patients, 1.5% received a first-ever RA diagnosis over a 12.39-year median follow-up.
The researchers used restricted cubic spline to analyze the associations between reproductive factors and RA risk, and Cox proportional hazard regressions to estimate HRs for RA.
According to the researchers, both early — ie, prior to age 12 years — menarche (HR = 1.19; 95% CI, 1.07-1.32) and menarche after the age of 14 years (HR = 1.17; 95% CI, 1.05-1.3) were associated with RA occurrence. However, after adjusting for confounding factors, the effect of early menarche weakened (HR = 1.09; 95% CI, 0.98-1.21), while later menarche still appeared to increase RA risk (HR = 1.13; 95% CI, 1.02-1.26).
As for the effects of menopause, RA risk was greater among postmenopausal patients (HR = 1.19; 95% CI, 1.05-1.36) and those with fewer than 33 reproductive years (HR = 1.39; 95% CI, 1.21-1.59). Women who went through menopause before the age of 45 years demonstrated greater RA risk (HR = 1.46; 95% CI, 1.27-1.67), compared with those who went through menopause at age 50 to 51 years.
RA risk was also heightened among patients reporting a history of hysterectomy (HR = 1.4; 95% CI, 1.25-1.56), oophorectomy (HR = 1.21; 95% CI, 1.08-1.35) and those who had used exogenous hormone replacement therapy (HR = 1.46; 95% CI, 1.35-1.57).
Jiang and colleagues wrote that, contradictory to previous research, pregnancy history had no statistically significant effect on RA risk, including in a sensitivity analysis that factored in overweight and obesity status. However, having four or more children was associated with higher RA risk (HR = 1.18; 95% CI, 1.04-1.34).
“This large prospective study among 223,526 women in the UK Biobank indicates that several hormonal and reproductive factors were associated with the risk of RA,” Jiang and colleagues wrote. “When diagnosing and managing women with RA, hormonal and reproductive aspects should be carefully evaluated.
“In particular, women in later menarche or early menopause require additional attention,” they added. “The findings of this study are significant and form a basis on which novel and target-specific intervention measures to curb the risk of RA in women may be developed. Furthermore, future studies should investigate the involvement of female hormones in the pathophysiology of RA.”
Collapse
Read more about
Click Here to Manage Email Alerts