Rheumatoid arthritis of menopause: there are more questions than answers

Abstract

The article is devoted to an urgent issue - rheumatoid arthritis (RA). The symptoms of arthritis appear in women during menopause. Literature data show that it is often during period of poor reproductive function that the disease first manifests itself in women. RA significantly affects the prognosis of women’s life expectancy and quality. The clinical and pathogenetic relationships between autoimmune diseases (one of which is RA) and the features of menopause remain poorly understood and require research. Basically, papers devoted to the problem present epidemiological studies and the study of the relationships between sex hormones levels and inflammatory mediators that are specific to RA.A literature review on the features of the onset and course of rheumatoid arthritis in menopausal women is presented. The most accepted in the literature explanations characterizing the relationship between changes during menopause and RA are arguments about the protective effect of estrogens on the cells of the musculoskeletal system and the ability of estrogens to influence the intensity of inflammation (systemic inflammation of low intensity associated with age). In the case of the development of rheumatoid arthritis in old age, higher levels of IL-6 and lower TNFa are revealed. This fact gives rise to the choice of basic therapy in favor of a humanized monoclonal antibody to the human interleukin-6 receptor - tocilizumab.The review may be of interest to both practising rheumatologists, neurologists, and gynecologists and general practitioners.

Keywords

• rheumatoid arthritis
• menopause
• perimenopause
• tocilizumab
• osteoporosis
• osteopenia
• systemic inflammation
• estrogens
• hormone replacement therapy