Influence of sex, age, and menopausal state on the course of early rheumatoid arthritis

Objective. To investigate the influences of the menopausal state, sex, and age on the course and outcome of rheumatoid arthritis (RA). Methods. A cohort of patients with early RA (209 female, 123 male) was stud ied. Sex, age, and menopausal state at baseline, and disease activity, radi ographic joint destruction, and physical disability during 6 years of follo wup were assessed. Results. The Disease Activity Score (DAS) was significantly higher in femal e compared to male patients at any time point except at the time of inclusi on. This was mainly due to postmenopausal patients. Radiographic joint dest ruction (RJD) was significantly worse in female patients compared to males at the time of inclusion. Postmenopausal patients had significantly higher RJD than premenopausal patients at the time of inclusion and 3 years therea fter. Older male patients showed worse RJD than younger male patients at al l time points measured. Physical disability was significantly worse in fema le compared to male patients, as well as in postmenopausal compared to prem enopausal patients, and older male compared to younger male patients. Stepw ise regression analysis revealed that at 3 years higher age and female sex were the best predictors for a worse DAS. Higher age and the interaction te rm between menopausal state and age best predicted higher RJD. Higher age a nd the interaction term between menopausal state and age best predicted Hea lth Assessment Questionnaire (HAQ) score. Conclusion. Higher age at presentation of RA leads to a more severe disease course in terms of DAS, RID, and HAQ. Although female sex has a deteriorat ing effect on the DAS, the menopausal state is responsible for the major pa rt of the differences in outcome between men and women. Postmenopausal stat e in early RA influences future disability and damage, especially in older patients.