Rheumatology and Women’s Health: 3 New Things

Sep 27, 2018

(1) Menopause worsens RA symptoms; (2) obesity increases disease activity in women with lupus; and (3) signs of cardiac disease appear early in SLE.

References1. Mollard E, Pedro S, Chakravarty E, et al. The impact of menopause on functional status in women with rheumatoid arthritis. Rheumatology. 2018;57:798-802. doi: 10.1093/rheumatology/kex526.2. Patterson S, Schmajuk G, Jafri K, Yazdany J, Katz P. Obesity independently associates with worse patient-reported outcomes in women with systemic lupus erythematosus. Arthritis Care Res. 2018 May 8. doi: 10.1002/acr.23576.3. Guo Q, Wu LM, Wang Z, et al. Early detection of silent myocardial impairment in patients with new onset drug-naÃ¯ve systemic lupus erythematosus - a three-center prospective study (Myocardial Impairment in New Onset SLE). Arthritis Rheumatol. 2018 Aug 2. doi: 10.1002/art.40671.

Highlights from three new studies include: (1) women with rheumatoid arthritis (RA) have a greater decline in physical function following menopause; (2) obesity increases disease activity in women with systemic lupus erythematosus (SLE); and (3) women with newly diagnosed lupus show signs of silent, early cardiovascular disease.^1-3 Scroll through the slides for the latest findings and their clinical implications.

A nationwide observational cohort study included 8189 women who developed rheumatoid arthritis (RA) before menopause. One-quarter of the women were premenopausal, 7.5% transitioned through menopause during the study, and 68.1% were postmenopausal.¹

After adjustment for other significant factors, the results showed that women who were premenopausal had less functional decline than women who were postmenopausal. Those women who had used hormonal replacement therapy, had been pregnant, or had a longer reproductive life had less functional decline. After menopause, the trajectory of functional decline worsened and accelerated.

Clinical Implications: “Not only is this decline causing suffering for women, it is costly to both individuals and the healthcare system as a whole. Research is specifically needed on the mechanism connecting these variables with the eventual goal of identifying interventions that can maintain or improve function in postmenopausal women with RA,” said lead author Elizabeth Mollard, PhD, of the University of Nebraska Medical Center in Omaha.

A sample of 148 patients (mean age, 48 years) with systemic lupus erythematosus (SLE) was taken from the Arthritis Body Composition and Disability Study. About one-third of the patients were obese.²

A multivariable analysis found that obesity was independently associated with worse patient-reported outcomes (PROs), including disease activity, depressive symptoms, and symptoms of pain and fatigue. This led to the conclusion that obesity may represent a modifiable target for improving outcomes in patients with SLE.

Clinical Implications: “Our findings have important clinical implications because the PROs we measured, particularly pain and fatigue, are known to have profound effects on quality of life and remain a major area of unmet need for people with lupus. The relationship we observed between excess fat and worse outcomes underscores the need for lifestyle interventions targeting lupus patients who are overweight. More research is needed in this area, but it is possible that such interventions will reduce both cardiovascular risk and the severity of debilitating symptoms common in this disease. In the meantime, I hope this work sparks greater interest and motivation among rheumatologists to address weight management with their lupus patients,” said lead author Sarah Patterson, MD, a fellow in rheumatology at the University of California, San Francisco.

A threeâcenter prospective study included 50 patients with drugânaive new-onset systemic lupus erythematosus (SLE), 60 patients with longstanding SLE, and 50 healthy subjects. Imaging tests revealed structural and functional changes in the hearts of patients with lupus, and the extent of the changes, including signs of fibrosis, were related to lupus stage. The findings indicate that early detection and treatment of heart problems may benefit patients with lupus.³

Clinical Implications: “Our findings may affect current lupus diagnostics and treatment, meaning more patients with silent cardiac insults could be identified and receive proper treatment," said senior author Jun Pu, MD, PhD, of Shanghai Jiao Tong University in China. Anti-fibrotic treatments may be appropriate once fibrosis appears at later stages, the researchers noted, but whether these treatments will improve a patient’s prognosis needs further evaluation in clinical studies.