Preview

Rheumatology Science and Practice

Advanced search

Menopause and rheumatoid arthritis (up to date)

https://doi.org/10.47360/1995-4484-2025-246-252

Abstract

Rheumatoid arthritis (RA) most often affects women, and the onset of RA often occurs around the middle age of menopause. RA in women, compared to men, is more severe, characterized by difficulties in achieving remission and a more negative prognosis. Research results indicate a relationship between menopause, estrogen levels and RA. Early menopause is characterized by an increased risk of developing RA, as well as difficulty achieving remission and a lower quality of life. Menopausal hormone therapy (MHT) may influence both the risk of developing RA and its course. Given the relationship between menopause and other conditions such as obesity, cardiovascular disease, osteoporosis and fibromyalgia, off-label MHT may be one of the possible ways to overcome treatment resistance in RA.

About the Authors

T. S. Panevin
V.A. Nasonova Research Institute of Rheumatology; Far Eastern State Medical University
Russian Federation

Taras S. Panevin.

115522, Moscow, Kashirskoye Highway, 34A; 680000, Khabarovsk, Muravyova-Amurskogo str., 35


Competing Interests:

None



A. A. Smetnik
National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov
Russian Federation

Antonina A. Smetnik.

117997, Moscow, Akademika Oparina str., 4


Competing Interests:

None



E. G. Zotkin
V.A. Nasonova Research Institute of Rheumatology
Russian Federation

Evgeniy G. Zotkin.

115522, Moscow, Kashirskoye Highway, 34A


Competing Interests:

None



E. L. Nasonov
V.A. Nasonova Research Institute of Rheumatology
Russian Federation

Evgeny L. Nasonov.

115522, Moscow, Kashirskoye Highway, 34A


Competing Interests:

None



References

1. Klareskog L, Stolt P, Lundberg K, Källberg H, Bengtsson C, Grunewald J, et al. A new model for an etiology of rheumatoid arthritis: Smoking may trigger HLA-DR (shared epitope)-restricted immune reactions to autoantigens modified by citrullination. Arthritis Rheum. 2006;54(1):38-46. doi: 10.1002/art.21575

2. Nagy G, Roodenrijs NMT, Welsing PM, Kedves M, Hamar A, van der Goes MC, et al. EULAR definition of difficult-to-treat rheumatoid arthritis. Ann Rheum Dis. 2021;80(1):31-35. doi: 10.1136/annrheumdis-2020-217344

3. Nasonov EL. Pharmacotherapy for rheumatoid arthritis: New strategy, new targets. Nauchno-Prakticheskaya Revmatologia = Rheumatology Science and Practice. 2017;55(4):409-419 (In Russ.). doi: 10.14412/1995-4484-2017-409-419

4. Nasonov EL, Olyunin YuA, Lila AM. Rheumatoid arthritis: The problems of remission and therapy resistance. Nauchno-Prakticheskaya Revmatologia = Rheumatology Science and Practice. 2018;56(3):363-271 (In Russ.). doi: 10.14412/1995-4484-2018-263-271

5. Kvien TK, Uhlig T, Ødegård S, Heiberg MS. Epidemiological aspects of rheumatoid arthritis: The sex ratio. Ann N Y Acad Sci. 2006;1069:212-222. doi: 10.1196/annals.1351.019

6. Harlow SD, Gass M, Hall JE, Lobo R, Maki P, Rebar RW, et al. Executive summary of the Stages of Reproductive Aging Workshop + 10: Addressing the unfinished agenda of staging reproductive aging. J Clin Endocrinol Metab. 2012;97(4):1159-1168. doi: 10.1210/jc.2011-3362

7. Jawaheer D, Maranian P, Park G, Lahiff M, Amjadi SS, Paulus HE. Disease progression and treatment responses in a prospective DMARD-naive seropositive early rheumatoid arthritis cohort: Does gender matter? J Rheumatol. 2010;37(12):2475-2485. doi: 10.3899/jrheum.091432

8. Kuiper S, van Gestel AM, Swinkels HL, de Boo TM, da Silva JA, van Riel PL. Influence of sex, age, and menopausal state on the course of early rheumatoid arthritis. J Rheumatol. 2001;28(8):1809-1816.

9. Alpizar-Rodriguez D, Förger F, Courvoisier DS, Gabay C, Finckh A. Role of reproductive and menopausal factors in functional and structural progression of rheumatoid arthritis: Results from the SCQM cohort. Rheumatology (Oxford). 2019;58(3):432-440. doi: 10.1093/rheumatology/key311

10. Cutolo M, Gotelli E. Complex role of oestrogens in the risk and severity of rheumatoid arthritis in menopause. RMD Open. 2023;9(2):e003176. doi: 10.1136/rmdopen-2023-003176

11. Cutolo M, Straub RH. Sex steroids and autoimmune rheumatic diseases: State of the art. Nat Rev Rheumatol. 2020;16(11):628-644. doi: 10.1038/s41584-020-0503-4

12. Straub RH. The complex role of estrogens in inflammation. Endocr Rev. 2007;28(5):521-574. doi: 10.1210/er.2007-0001

13. Islander U, Jochems C, Lagerquist MK, Forsblad-d’Elia H, Carlsten H. Estrogens in rheumatoid arthritis; the immune system and bone. Mol Cell Endocrinol. 2011;335(1):14-29. doi: 10.1016/j.mce.2010.05.018

14. Kim OY, Chae JS, Paik JK, Seo HS, Jang Y, Cavaillon JM, et al. Effects of aging and menopause on serum interleukin-6 levels and peripheral blood mononuclear cell cytokine production in healthy nonobese women. Age (Dordr). 2012;34(2):415-425. doi: 10.1007/s11357-011-9244-2

15. Al-Salman H. 17β-estradiol hormone and interleukin 1-beta change related to menopause in the women with rheumatoid arthritis. Asian J Pharm. 2019;13(02). doi: 10.22377/ajp.v13i02.31066

16. Engdahl C, Bondt A, Harre U, Raufer J, Pfeifle R, Camponeschi A, et al. Estrogen induces St6gal1 expression and increases IgG sialylation in mice and patients with rheumatoid arthritis: A potential explanation for the increased risk of rheumatoid arthritis in postmenopausal women. Arthritis Res Ther. 2018;20(1):84. doi: 10.1186/s13075-018-1586-z

17. Ohmi Y, Ise W, Harazono A, Takakura D, Fukuyama H, Baba Y, et al. Sialylation converts arthritogenic IgG into inhibitors of collagen-induced arthritis. Nat Commun. 2016;7:11205. doi: 10.1038/ncomms11205

18. Gupta P, Sághy T, Nordqvist J, Nilsson J, Carlsten H, Horkeby K, et al. Impact of estrogen on IgG glycosylation and serum protein glycosylation in a murine model of healthy postmenopause. Front Endocrinol (Lausanne). 2023;14:1243942. doi: 10.3389/fendo.2023.1243942

19. Zhang X, Qiao P, Guo Q, Liang Z, Pan J, Wu F, et al. High follicle-stimulating hormone level associated with risk of rheumatoid arthritis and disease activity. Front Endocrinol (Lausanne). 2022;13:862849. doi: 10.3389/fendo.2022.862849

20. Qian H, Jia J, Yang Y, Bian Z, Ji Y. A follicle-stimulating hormone exacerbates the progression of periapical inflammation through modulating the cytokine release in periodontal tissue. Inflammation. 2020;43(4):1572-1585. doi: 10.1007/s10753-020-01234-9

21. Mumusoglu S, Yildiz BO. Metabolic syndrome during menopause. Curr Vasc Pharmacol. 2019;17(6):595-603. doi: 10.2174/1570161116666180904094149

22. Pamuk ON, Dönmez S, Cakir N. Increased frequencies of hysterectomy and early menopause in fibromyalgia patients: A comparative study. Clin Rheumatol. 2009;28(5):561-564. doi: 10.1007/s10067-009-1087-1

23. Eisenberger NI, Inagaki TK, Rameson LT, Mashal NM, Irwin MR. An fMRI study of cytokine-induced depressed mood and social pain: The role of sex differences. Neuroimage. 2009;47(3):881-890. doi: 10.1016/j.neuroimage.2009.04.040

24. Karateev AE, Nasonov EL. Chronic pain and central sensitization in immuno-inflammatory rheumatic diseases: Pathogenesis, clinical manifestations, the possibility of using targeted disease modifying antirheumatic drugs. Nauchno-Prakticheskaya Revmatologia = Rheumatology Science and Practice. 2019;57(2):197-209 (In Russ.). doi: 10.14412/1995-4484-2019-197-209

25. Panevin TS, Bobkova AO, Karateev AE, Zotkin EG. Endogenous estrogen deficiency and the development of chronic musculoskeletal pain: A review. Terapevticheskii arkhiv. 2022;94(5):683-688 (In Russ.). doi: 10.26442/00403660.2022.05.201490

26. Krougly LB, Fomicheva OA, Karpov YA, Popkova TV, Novikova DS, Nasonov EL. Cardiovascular complications of rheumatoid arthritis: Prevalence and pathogenesis. Kardiologiia. 2016;6:89-95 (In Russ.). doi: 10.18565/cardio.2016.6.89-95

27. Lee E, Anselmo M, Tahsin CT, Vanden Noven M, Stokes W, Carter JR, et al. Vasomotor symptoms of menopause, autonomic dysfunction, and cardiovascular disease. Am J Physiol Heart Circ Physiol. 2022;323(6):H1270-H1280. doi: 10.1152/ajpheart.00477.2022

28. Osipova IV, Starodubova YN. Prediction of cardiovascular diseases in women with rheumatoid arthritis. Kardiologiia. 2024;64(1):67-79 (In Russ.). doi: 10.18087/cardio.2024.1.n2616

29. Gomez-Ramirez EE, Ramirez-Villafaña M, Gamez-Nava JI, Cons-Molina F, Rodriguez Jimenez NA, Saldaña-Cruz AM, et al. Risk factors of muscle wasting in women with rheumatoid arthritis: Relevance of the persistent failure of conventional combination therapy. Healthcare (Basel). 2022;10(10):2004. doi: 10.3390/healthcare10102004

30. Russian Society of Obstetricians and Gynecologists. Menopause and climacteric state in women: Clinical guidelines. Moscow;2021 (In Russ.).

31. Panevin TS, Ledina AV, Zotkin EG. Menopause and premature ovarian insufficiency in rheumatic diseases: A review. Gynecology. 2023;25(4):428-434 (In Russ.). doi: 10.26442/20795696.2023.4.202366

32. Brouwer J, Laven JS, Hazes JM, Schipper I, Dolhain RJ. Levels of serum anti-Müllerian hormone, a marker for ovarian reserve, in women with rheumatoid arthritis. Arthritis Care Res (Hoboken). 2013;65(9):1534-1538. doi: 10.1002/acr.22013

33. Brouwer J, Dolhain RJEM, Hazes JMW, Visser JA, Laven JSE. Reduced ovarian function in female rheumatoid arthritis patients trying to conceive. ACR Open Rheumatol. 2019;1(5):327-335. doi: 10.1002/acr2.11043

34. Eudy AM, McDaniel G, Hurd WW, Clowse MEB. Fertility and ovarian reserve among women with rheumatoid arthritis. J Rheumatol. 2019;46(5):455-459. doi: 10.3899/jrheum.180176

35. Jiang LQ, Zhang RD, Musonye HA, Zhao HY, He YS, Zhao CN, et al. Hormonal and reproductive factors in relation to the risk of rheumatoid arthritis in women: A prospective cohort study with 223 526 participants. RMD Open. 2024;10(1):e003338. doi: 10.1136/rmdopen-2023-003338

36. Beydoun HA, el-Amin R, McNeal M, Perry C, Archer DF. Reproductive history and postmenopausal rheumatoid arthritis among women 60 years or older: Third National Health and Nutrition Examination Survey. Menopause. 2013;20(9):930-935. doi: 10.1097/GME.0b013e3182a14372

37. Banas T, Hajdyla-Banas I, Pitynski K, Niewegłowska D, Juszczyk G, Ludwin A, et al. Age at natural menopause in women on long-term methotrexate therapy for rheumatoid arthritis. Menopause. 2016;23(10):1130-1138. doi: 10.1097/GME.0000000000000674

38. Park EH, Kang EH, Lee YJ, Ha YJ. Impact of early age at menopause on disease outcomes in postmenopausal women with rheumatoid arthritis: A large observational cohort study of Korean patients with rheumatoid arthritis. RMD Open. 2023;9(1):e002722. doi: 10.1136/rmdopen-2022-002722

39. Wong LE, Huang WT, Pope JE, Haraoui B, Boire G, Thorne JC, et al. Effect of age at menopause on disease presentation in early rheumatoid arthritis: Results from the Canadian Early Arthritis Cohort. Arthritis Care Res (Hoboken). 2015;67(5):616-623. doi: 10.1002/acr.22494

40. Salliot C, Nguyen Y, Gelot A, Mariette X, Boutron-Ruault MC, Seror R. Lifetime female hormonal exposure and risk of rheumatoid arthritis in postmenopausal women: Results from the French E3N cohort. Joint Bone Spine. 2022;89(5):105374. doi: 10.1016/j.jbspin.2022.105374

41. Walitt B, Pettinger M, Weinstein A, Katz J, Torner J, Wasko MC, et al. Effects of postmenopausal hormone therapy on rheumatoid arthritis: The women’s health initiative randomized controlled trials. Arthritis Rheum. 2008;59(3):302-310. doi: 10.1002/art.23325

42. Jeong HS, Hong SJ, Choi SJ, Kim JH, Song GG, Jung JH. Effects of oral contraceptives on rheumatoid arthritis in Korean menopausal women: A nationwide cross-sectional study. Maturitas. 2018;112:24-28. doi: 10.1016/j.maturitas.2018.03.017

43. Orellana C, Saevarsdottir S, Klareskog L, Karlson EW, Alfredsson L, Bengtsson C. Postmenopausal hormone therapy and the risk of rheumatoid arthritis: Results from the Swedish EIRA population-based case-control study. Eur J Epidemiol. 2015;30(5):449-457. doi: 10.1007/s10654-015-0004-y

44. Yuk JS, Seo YS, Im YH, Kim JH. Menopausal hormone therapy and risk of seropositive rheumatoid arthritis: A nationwide cohort study in Korea. Semin Arthritis Rheum. 2023;63:152280. doi: 10.1016/j.semarthrit.2023.152280

45. Eun Y, Jeon KH, Han K, Kim D, Kim H, Lee J, et al. Menopausal factors and risk of seropositive rheumatoid arthritis in postmenopausal women: A nationwide cohort study of 1.36 million women. Sci Rep. 2020;10(1):20793. doi: 10.1038/s41598-020-77841-1

46. Hadizadeh F, Johansson T, Johansson Å, Karlsson T, Ek WE. Effects of oral contraceptives and menopausal hormone therapy on the risk of rheumatoid arthritis: A prospective cohort study. Rheumatology (Oxford). 2024;63(8):2101-2108. doi: 10.1093/rheumatology/kead513

47. Diaz-Ruano AB, Martinez-Alarcon N, Perán M, Benabdellah K, Garcia-Martinez MLÁ, Preda O, et al. Estradiol and estrone have different biological functions to induce NF-κB-driven inflammation, EMT and stemness in ER+ cancer cells. Int J Mol Sci. 2023;24(2):1221. doi: 10.3390/ijms24021221

48. Panevin TS, Yureneva SV, Zotkin EG, Kosheleva NM. Morphological structure of the placenta as a result of its increment. Russian Journal of Human Reproduction. 2022;28(1):149-158 (In Russ.). doi: 10.17116/repro20222801114

49. Daraghmeh DN, Hopkins AM, King C, Abuhelwa AY, Wechalekar MD, Proudman SM, et al. Female reproductive status and exogenous sex hormone use in rheumatoid arthritis patients treated with tocilizumab and csDMARDs. Rheumatology (Oxford). 2023;62(2):583-595. doi: 10.1093/rheumatology/keac357

50. Safiri S, Kolahi AA, Hoy D, Smith E, Bettampadi D, Mansournia MA, et al. Global, regional and national burden of rheumatoid arthritis 1990–2017: A systematic analysis of the Global Burden of Disease study 2017. Ann Rheum Dis. 2019;78(11):1463-1471. doi: 10.1136/annrheumdis-2019-215920


Review

For citations:


Panevin T.S., Smetnik A.A., Zotkin E.G., Nasonov E.L. Menopause and rheumatoid arthritis (up to date). Rheumatology Science and Practice. 2025;63(3):246-252. (In Russ.) https://doi.org/10.47360/1995-4484-2025-246-252

Views: 82


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 1995-4484 (Print)
ISSN 1995-4492 (Online)