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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