POS0109 IMPACT OF EARLY AGE AT MENOPAUSE ON DISEASE OUTCOMES IN POSTMENOPAUSAL WOMEN WITH RHEUMATOID ARTHRITIS: RESULTS FROM A LARGE OBSERVATIONAL COHORT OF KOREAN PATIENTS WITH RHEUMATOID ARTHRITIS

Abstract

BackgroundThe increased prevalence of rheumatoid arthritis (RA) in women has led to studies exploring how female reproductive factors affect disease outcomes in women RA. While a few studies have investigated how early menopause (EM) affects RA outcomes, they had relatively small sample size and have shown inconsistent results [1, 2]. Moreover, none has evaluated the association between age at menopause and longitudinal changes in validated disease activity indices or patient-reported outcomes (PROs) of RA.ObjectivesWe aimed to assess the differences in clinical outcomes between RA patients with EM (age at menopause <45 years) and usual menopause (UM) (age at menopause ≥45 years), and identify potential impact of EM on longitudinal changes in RA activity and PROs during follow-up period.MethodsA total of 2,878 postmenopausal women with RA were included from the Korean Observational Study Network for Arthritis, a nationwide prospective RA cohort of Korea. Each patient was examined at baseline and for 5 consecutive years using the simplified disease activity index (SDAI), health assessment questionnaire-disability index (HAQ-DI), and other PROs. Among patients with a baseline SDAI >11, generalized estimating equation (GEE) analyses were performed to evaluate the impact of EM on longitudinal changes in RA activity and PROs during follow-up.ResultsThe EM group (N=437) was younger than the UM group (N=2,441) [58.0±9.5 vs. 60.8±8.0 years, p<0.001], but RA duration was similar between the two groups. The EM group had higher education level and was more likely to be seronegative at enrollment. Moreover, the EM group demonstrated higher disease activity [SDAI 15.4±11.7 vs. 13.9±10.0, p=0.011] and patient-reported visual analogue scale (VAS) scores for global assessment, fatigue, and sleep disturbance (all p<0.05), and worse EQ-5D-VAS [59.9 ±22.2 vs. 63.0±19.5, p= 0.006] at baseline. The rate of previous fracture and neoplastic disease, especially uterine/cervical neoplasm, was higher while that of hypertension was lower among the EM group. The GEE model revealed that EM significantly influenced the rate of SDAI change (β=1.265, p=0.004), after adjusting for age, RA duration, biologic use, and SDAI at baseline. The EM group was also significantly associated with increase in HAQ-DI (β=0.088, p=0.003), and decrease in EQ-5D utility value (β=-0.031, p=0.016) during 5-year follow-up period.ConclusionRA patients with EM demonstrate higher disease activity and poorer health-related quality of life. EM significantly affects longitudinal changes in disease activity and PROs in RA.