Perimenopause in women with rheumatologic diseases: a spotlight on an under-addressed transition

Abstract

Abundant research has been published describing the effects invoked during menopause across different organ systems. Changing levels of estrogen and progesterone result in bidirectional alterations of immune cell pathways. Overall, the net trend dampens immunoregulation and promotes inflammation. In paradigmatic rheumatologic diseases, the combined effect is far from predictable. While some features may abate during menopause, studies have shown a general increased frequency toward disease exacerbation. Similarly, while impossible to isolate the ramifications of menopause in women with fibromyalgia, a tendency toward enhanced symptoms is unquestionably apparent. Furthermore, the comorbidities accrued by increasing age and the consequences of long-term medication use may also confound this picture. Periodic rheumatologic visits are warranted, with clinical assessments directed toward a multi-disciplinary approach. Ultimately, while an arsenal of effective tools is available for caring for these women and their underlying conditions, more studies are needed to better clarify how the different stages surrounding perimenopause affect subpopulations with rheumatic diseases and fibromyalgia-related disorders so that clinical course can be predicted and addressed prior to the emergence of symptomatology.

摘要

大量的研究已经发表, 描述了绝经对不同器官系统的影响。雌激素和孕激素水平的变化会导致免疫细胞途径的双向变化。总体而言, 这种网络趋势抑制免疫调节并促进炎症。在风湿性聚集性疾病中, 这种联合效应是不可预测的。虽然一些特征在绝经期间可能会减弱, 但研究表明, 疾病恶化的频率普遍增加。同样, 尽管无法分离出患有纤维肌痛的女性绝经的影响, 但症状增强的趋势是显而易见的。此外, 年龄增长引起的合并症以及长期药物使用的后果也可能会混淆这种情况。有必要定期进行风湿病学检查, 并采用多学科方法进行临床评估。最后, 虽然有大量有效的工具可用于保护这些妇女及其潜在的疾病, 但还需要更多的研究来更好地阐明围绝经的不同阶段如何影响风湿病和纤维肌痛相关疾病的亚群, 以便在出现症状之前预测和处理临床过程。

Keywords:

• Menopause
• perimenopause
• autoimmune
• rheumatoid arthritis
• systemic lupus erythematosus
• systemic scleroderma
• fibromyalgia

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.