Gulati Malvika, Brewer Gretchen, Judge Andrew, Kennedy Donna, Vincent Tonia L, Watt Fiona E
Centre for Osteoarthritis Pathogenesis Versus Arthritis, Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, United Kingdom.
Department of Rheumatology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.
Front Pain Res (Lausanne). 2024 Feb 12;5:1331187. doi: 10.3389/fpain.2024.1331187. eCollection 2024.
Hand osteoarthritis is more common in women, and its risk increases around the time of the menopause. We set out to describe the timing between menopause and the onset of symptomatic hand osteoarthritis (OA), and associations with the use of hormone replacement therapy (HRT) or its discontinuation, describing any identifiable subgroups of women.
Retrospective healthcare-records study of sequential women referred to a specialist hand OA clinic, 2007-2015. Confirmation of hand OA diagnosis was by clinican, by accepted criteria. Demographics and clinical variables were from healthcare-records, recorded by standardised proforma. Outcomes of interest were reported age of onset of hand symptoms, reported age at final menstrual period (FMP), time from FMP to reported onset of hand symptoms and time from cessation of HRT to reported onset of hand symptoms. Exposure categories for systemic HRT use were never users, current users, previous users. Analysis of Variance compared groups; linear regression analysed associations of exposure with outcome.
82/92(89%) of eligible women were post-menopausal, mean age at FMP 49.9 years (SD5.4). In these post-menopausal women, median time from FMP to hand symptom onset was 3 years. 48/82 (59%) developed hand symptoms within the defined peri-menopausal period (FMP ± 4 years), whilst some women developed their symptoms before or after (range -25, 30 years). In women who discontinued HRT prior to symptom onset, the median time from HRT cessation to onset of hand symptoms was 6 months. Past HRT users were older at hand symptom onset than women who had not taken HRT [coeff.4.7 years (0.92, 8.39); = 0.015].
This study adds to evidence associating the menopause/sex hormone deficiency with hand OA symptom onset in a sizeable subgroup of women (but not all). HRT use/cessation appears to influence the timing of onset of hand OA symptoms. It is not possible to interpret from this type of study whether sex hormone deficiency is causative of disease or modulates its symptoms. It is also not possible to judge whether painful hand osteoarthritis in post-menopausal women is a subtype of disease. Further investigation is indicated of sex-specific subtypes and potential for personalised medicine for post-menopausal women with hand osteoarthritis, as a clearly definable high-risk subgroup.
手部骨关节炎在女性中更为常见，且在绝经前后其风险会增加。我们旨在描述绝经与有症状的手部骨关节炎（OA）发病之间的时间关系，以及与激素替代疗法（HRT）使用或停用的关联，并描述可识别的女性亚组。
对2007年至2015年转诊至手部OA专科诊所的连续女性进行回顾性医疗记录研究。手部OA诊断由临床医生根据公认标准进行确认。人口统计学和临床变量来自医疗记录，通过标准化表格记录。感兴趣的结果包括报告的手部症状发病年龄、报告的末次月经年龄（FMP）、从FMP到报告的手部症状发病时间以及从HRT停用至报告的手部症状发病时间。全身性HRT使用的暴露类别为从未使用者、当前使用者、既往使用者。方差分析比较各组；线性回归分析暴露与结果的关联。
92名符合条件的女性中有82名（89%）已绝经，FMP时的平均年龄为49.9岁（标准差5.4）。在这些绝经后女性中，从FMP到手部症状发作的中位时间为3年。48/82（59%）在定义的围绝经期（FMP±4年）内出现手部症状，而一些女性在围绝经期之前或之后出现症状（范围为-25至30年）。在症状发作前停用HRT的女性中，从HRT停用至手部症状发作的中位时间为6个月。既往使用HRT的女性手部症状发作时的年龄比未使用HRT的女性大[系数4.7岁（0.92，8.39）；P=0.015]。
本研究补充了证据，表明在相当一部分女性（但并非全部）中，绝经/性激素缺乏与手部OA症状发作有关。HRT的使用/停用似乎会影响手部OA症状发作的时间。从这类研究中无法判断性激素缺乏是疾病的病因还是调节其症状。也无法判断绝经后女性手部疼痛性骨关节炎是否为疾病亚类型。对于绝经后手部骨关节炎女性这一明确可定义的高风险亚组，有必要进一步研究性别特异性亚类型及个性化医疗的潜力。
