Department of Obstetrics and Gynecology, Kochi Health Sciences Center, Kochi City, Japan.
Department of Rheumatology, Chikamori Hospital, Kochi City, Japan.
J Obstet Gynaecol Res. 2022 Jul;48(7):2005-2009. doi: 10.1111/jog.15287. Epub 2022 May 20.
Patients with rheumatoid arthritis may demonstrate fluctuations in arthritis symptoms associated with the menstrual cycle. This is the first case report of successful control of menstrual cycle-related exacerbation of rheumatoid arthritis with a gonadotropin-releasing hormone agonist and add-back therapy. A 49-year-old premenopausal woman experienced recurrent severe arthritis flares despite aggressive immunotherapy. Her arthritis symptoms started 10 days before her menstruation and spontaneously resolved after the initiation of menstruation. We chose a gonadotropin-releasing hormone agonist with percutaneous estradiol gel to prevent a hypoestrogenic state and a levonorgestrel-releasing intrauterine system to facilitate uterine protection by estrogen. Thereafter, her symptoms significantly improved without experiencing major flares. In addition, she did not demonstrate any menopausal symptoms. This case highlights that rheumatoid arthritis disease activity may be associated with the menstrual cycle, and hormonal therapy may be beneficial as an adjunct therapy for controlling premenstrual exacerbation of rheumatoid arthritis.
类风湿关节炎患者的关节炎症状可能与月经周期有关，出现波动。这是首例使用促性腺激素释放激素激动剂和激素补充疗法成功控制与月经周期相关的类风湿关节炎加重的病例报告。一名 49 岁的绝经前女性尽管接受了强化免疫治疗，但仍反复发作严重的关节炎。她的关节炎症状在月经前 10 天开始，在月经开始后自行缓解。我们选择使用促性腺激素释放激素激动剂联合经皮雌二醇凝胶预防雌激素缺乏状态，以及左炔诺孕酮宫内释放系统来促进雌激素对子宫的保护。此后，她的症状显著改善，且未出现严重的发作。此外，她没有出现任何更年期症状。该病例提示类风湿关节炎的疾病活动可能与月经周期有关，激素治疗可能有益于作为控制类风湿关节炎经前期加重的辅助治疗。
