Wednesday, February 7, 2018

Menopause has Negative Impact on Rheumatoid Arthritis Development

Recent Study

Rheumatoid arthritis (RA) and menopause are linked, according to new research that involved observations of arthritic symptoms in pre-menopausal and post-menopausal women. The research that was recently published in Rheumatology is based on a study of 8,189 middle-aged women who were suffering from rheumatoid arthritis.

While rheumatoid arthritis rates in women are three times higher than in men, and women with RA have more severe physical decline and disability, sex-based differences in RA are poorly understood, the researchers said.

Rheumatoid arthritis is an autoimmune disorder that causes inflammation and pain in the joints.

Interactions between levels of sex hormones (estrogen, progesterone) and the immune system are complex, but decreases in hormone production, as occurs during menopause, can be associated with an increase in disease activity in RA. Indeed, early menopause may be a factor that increases risk for developing RA and the post-menopausal period is associated with the most significant levels of joint damage and disability in women with RA.

The study is based on the previously established connection between hormonal changes in women suffering from rheumatoid arthritis and their physical function. Hormonal changes during pregnancy and childbirth were observed to have a positive impact on the physical condition of women with rheumatoid arthritis, whereas women in the post-partum phase would experience a flare-up of the disease.

In addition, doctors observed that women who experienced early or premature menopause were more likely to develop rheumatoid arthritis compared to those who experienced it at the normal age or even later in life.

These observations helped scientists establish links between rheumatoid arthritis and the reproductive events in their lives. In order to investigate further, scientists decided to study menopause in relation to rheumatoid arthritis.

"Further study is needed as to why women with rheumatoid arthritis are suffering a greater decline in function after menopause," said the study's lead author, Elizabeth Mollard, PhD, an assistant professor in the College of Nursing at the University of Nebraska Medical Center.

Early menopause and risk of RA

Results from a large study conducted in Sweden that examined associations between reproductive factors and RA found that women who went through menopause early (at or below the age of 45 years) were significantly more likely to develop RA.

Menopause and increased risk of disability

Menopause appears to influence the course of RA, leading to an increase in the activity of the disease and an increase in disability associated with RA.

One study found that post-menopausal women with RA had significantly higher levels of joint damage visible on radiography and significantly greater levels of physical disability than their pre-menopausal counterparts.

Menopause and bone loss

The period shortly before menopause (1.5 years before) and the period following menopause are associated with loss of bone, with bone density decreasing on average at a rate of 2.5% yearly during peri-menopause and at a slower rate (about 1%) after menopause. This rapid loss of bone can result in osteoporosis, which affects approximately 35% of post-menopausal Caucasian women, significantly increasing the risk for fractures, including spinal compression fracture and hip fracture.

Women with RA, who already face a risk of bone loss associated with chronic inflammation, face additional increased risk of osteoporosis from menopause. This means that they are at extremely high risk for fractures and other complications associated with continued bone loss.

Menopause and cardiovascular risk

Following menopause, women in the general population face significantly increased risk for cardiovascular disease. In fact, while rates of cardiovascular disease in women are approximately one-third of those in men before menopause, after menopause rates of cardiovascular disease in women increase to roughly the same level as those in men. Loss of the hormone estrogen with menopause causes a rise in low-density lipid levels and total cholesterol, as well as changes that affect blood vessels.

In women with RA, changes that occur with menopause can lead to a pronounced increase in the risk for cardiovascular disease, a risk that is already increased due to chronic inflammation associated with RA.

Counteracting the increased risk that comes with menopause

There are a number of things that you can do to counteract the increased health risks that come with menopause. The first is to make sure that you are treating and controlling your RA optimally. Working closely with your doctor to find the right treatments at all stages of RA can help you prevent joint damage and other related health problems. There are more treatment options for RA now than ever before and many available treatments can minimize and, in some cases, prevent damage and help you to maintain optimal functioning.

In addition to getting the right treatment for RA, you should also pay close attention to your risk for other health conditions that commonly affect postmenopausal women, principally cardiovascular disease and osteoporosis. Make sure that you and your doctor monitor for the signs of cardiovascular disease (high blood pressure, high cholesterol) and bone loss and treat these conditions as they arise. You can also reduce your risk for cardiovascular disease if you smoke by kicking the habit.

What else you can do:

·         Stay active. Weight-bearing exercises, including brisk walking, helps strengthen and build bone.
·         Try yoga. Yoga's emphasis on stretching, whole-body well-being, and group involvement makes the practice especially relevant to some arthritis sufferers.
·         Stretch it out. Assuming you are pain-free, you should try to stretch all of your joints each day. A physical therapist or other physician can help tailor a stretching program for your needs. People with RA tend to feel stiffer in the morning than at other times of the day, so take a shower to warm up your joints, and then stretch to help loosen you up for the rest of the day.
·         Get plenty of calcium. Milk, yogurt and other dairy products are rich in calcium, which is crucial for strong bones. Non-dairy calcium sources include leafy green vegetables and canned sardines with bones. Also ask your doctor if a calcium supplement is right for you.
·         Get more vitamin D. Your body needs vitamin D to absorb calcium and build healthy bones.  Vitamin D food sources include fatty fish such as salmon, mackerel and tuna, egg yolks, cheese and fortified milk, juice and cereal products. Your body also makes vitamin D when you spend time in the sun. Finally, ask your doctor if a vitamin D supplement is right for you.
·         Drink alcohol (in moderation). If you have RA, it seems fine to drink in moderation. Research suggests that people with RA who drink alcohol may have less severe symptoms than those who do not.
·         Have a good night sleep. Hot flashes, night sweats and insomnia related to menopause can make it tough to get a good night sleep. And too little sleep can exacerbate the pain and fatigue of RA. Use the good habits to improve your chances for a good sleep and a good rest:
o    Do not eat a heavy meal before bed.
o    Do not drink caffeinated beverages or alcohol before bed.
o    Do not watch TV in the bedroom.
o    Keep your bedroom comfortably cool, quiet and dark.
·         Train your mind and body. Mind-body therapies help you use your mind to make your body feel better. These approaches can include mindfulness meditation, biofeedback, breathing exercises, and guided relaxation. Certain types of exercises, such as moving meditation, qigong, and tai chi also encourage you to focus your mind in ways that can help you cope with pain, and improve strength and flexibility at the same time.
·         Give it a rest. Taking a break can relax your mind, ease pain in your joints, and help reduce the fatigue that's often associated with RA. On the flip side, avoid too much rest. An inactive lifestyle can be harmful, so intermingle rest periods with activity.
·         Take a warm bath or shower. Moist heat provides relief from rheumatoid arthritis pain by loosening muscles, tendons, and ligaments, as well as increasing blood flow. So, taking a warm bath or shower can be a real relaxation session. Also, moist heating pads, available at most pharmacies, can be applied for 10 to 15 minutes at a time for temporary pain relief.
·         Get a massage. Depending on how your body is feeling, massages can be wonderful or agonizing. If your joints and muscles aren't feeling too tender, massages can ease muscle tension related to joint stress. You will be the best judge of whether massage can help you on a particular day, or not. So, give it a try! But make sure your massage therapist has experience in treating people with RA.
·         Check out acupuncture. Some people say this ancient Eastern healing technique can trigger the body to release the "feel-good" hormones known as endorphins, thus reducing pain. But skeptics believe it's just the placebo effect. Only a handful of small studies have shown that acupuncture can help with RA symptoms. Still, many people swear by acupuncture, and there's really no downside to giving it a try unless you're scared of needles.

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