Menopause in systemic sclerosis: the impact on clinical presentation in a multicenter cross-sectional analysis from the National Registry of the Italian Society for Rheumatology (SPRING-SIR).
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Orlandi Martina, Giuggioli Dilia, Ferri Clodoveo, De Angelis Rossella, Riccieri Valeria, Cacciapaglia Fabio, Bosello Silvia Laura, Codullo Veronica, Bajocchi Gianluigi, Dagna Lorenzo, Campochiaro Corrado, De Luca Giacomo, Zanframundo Giovanni, Foti Rosario, Cuomo Giovanna, Ariani Alarico, Rosato Edoardo, Girelli Francesco, Zanatta Elisabetta, Cavazzana Ilaria, Ingegnoli Francesca, De Santis Maria, Murdaca Giuseppe, Abignano Giuseppina, Petitti Giorgio, Della Rossa Alessandra, Caminiti Maurizio, Iuliano Anna Maria, Ciano Giovanni, Beretta Lorenzo, Bagnato Gianluca, Lubrano Ennio, De Andres Ilenia, Giollo Alessandro, Saracco Marta, Agnes Cecilia, Cipolletta Edoardo, Lumetti Federica, Spinella Amelia, Magnani Luca, Visalli Elisa, Iandoli Carlo, Gigante Antonietta, Pellegrino Greta, Pigatto Erika, Lazzaroni Maria Grazia, Franceschini Franco, Generali Elena, Mennillo Gianna, Barsotti Simone, Pagano Mariano Giuseppa, Furini Federica, Vultaggio Licia, Parisi Simone, Peroni Clara Lisa, Bianchi Gerolamo, Fusaro Enrico, Sebastiani Gian Domenico, Govoni Marcello, D'Angelo Salvatore, Cozzi Franco, Doria Andrea, Salvarani Carlo, Iannone Florenzo, Guiducci Serena, Bellando-Randone Silvia, Matucci-Cerinic Marco, Bruni Cosimo
Аннотация
OBJECTIVES: Our study aimed to evaluate the association of (1) current menopausal status, (2) early menopause, and (3) disease onset during fertile or post-menopausal age on SSc clinical phenotype in a large SSc cohort from the Italian Systemic sclerosis Progression INvestiGation (SPRING-SIR) registry.
DESIGN: Female SSc patients from the SPRING-SIR registry, fulfilling the American College of Rheumatology (ACR)/European Alliance of Associations for Rheumatology (EULAR) 2013 classification criteria, with data on SSc disease onset, menopausal status, and menopausal age, were eligible. SSc onset was categorized as pre-menopausal if SSc onset happened >1 year before menopause or as post-menopausal onset if it occurred >1 year after menopause. An early menopause was defined by a menopausal age <45 years.
METHODS: Descriptive statistics and regression models were built to test the association between current menopausal status, pre-menopausal disease onset, and early menopause with SSc-related features.
RESULTS: At baseline, 1157/1538 (75%) patients were in menopause, 632 (50.4%) had a pre-menopausal SSc onset, and 130 (14.4%) reported an early menopause. Post-menopausal patients had more frequent limited cutaneous SSc, anti-centromere antibody positivity, interstitial lung disease, and gastrointestinal manifestations. Pre-menopausal onset cases showed more frequent diffuse cutaneous involvement and peripheral vasculopathy. Patients with early menopause had more frequent peripheral vasculopathy and interstitial lung disease, being early menopause an independent risk factor for digital ulcers and lower diffusing capacity of the lung for carbon monoxide.
CONCLUSION: Current post-menopausal status and early menopause may impact SSc presentation, being associated with vascular and gastrointestinal manifestations. Menopausal status and age should therefore be thoroughly addressed, aiming at better disease management.