Faculty Bibliography

OBJECTIVE:Studies suggest that hormonal states affect disease characteristics in women with rheumatoid arthritis (RA). This study investigated how age at menopause affects disease in women presenting with early RA. METHODS:This was a cross-sectional study of postmenopausal women with early RA under age 65 years at time of enrollment in the Canadian Early Arthritis Cohort. RA-related disease characteristics in women who had early age at menopause (EM; age at menopause <45 years) were compared to those who had usual age at menopause (age at menopause ≥45 years). The t-test was applied to continuous variables and the chi-square test to categorical variables. Multivariate logistic regression analysis was used to adjust for age at menopause, smoking, and use of exogenous hormones. RESULTS:A total of 534 women were included; 93 were in the EM group. The age at RA onset was similar between groups. The EM group had higher mean patient global and pain scores and was more likely to be rheumatoid factor (RF) positive and meet the 1987 American College of Rheumatology criteria for RA. Using multivariate logistic regression, the EM group was more likely to be RF positive (odds ratio 2.2 [95% confidence interval 1.3-3.8], P = 0.005). Symptom duration, joint counts, Disease Activity Score in 28 joints, Health Assessment Questionnaire scores, and inflammatory markers did not differ between groups. CONCLUSION/CONCLUSIONS:These data suggest that early age at menopause, compared to usual age at menopause, is associated with seropositivity in women with early RA.

Both traditional and disease-related risk factors for venous thromboembolism (VTE) must be considered when assessing rheumatic disease patients preoperatively. While many studies suggest that patients with rheumatic diseases are at higher risk of VTE overall, studies in rheumatoid arthritis patients do not demonstrate an increased risk of postoperative VTE. Here, we review the literature on VTE risk in patients with rheumatoid arthritis, systemic lupus erythematosus, Behcet's disease, and vasculitis. The data suggest that disease activity is a driver of VTE risk. While rheumatoid arthritis patients undergoing elective arthroplasty are not at elevated VTE risk, patients with systemic lupus erythematosus and antiphospholipid antibody syndrome undergoing surgery have an elevated risk of postoperative VTE.