Could sex-specific subtypes of hand osteoarthritis exist? A retrospective study in women presenting to secondary care

Malvika Gulati, Gretchen Brewer, Andrew Judge, Donna Kennedy, Tonia Vincent, Fiona Watt

Research output: Contribution to journalArticle (Academic Journal)peer-review

Abstract

Introduction: Hand osteoarthritis is more common in women, and its risk increases around the time of the menopause. We set out to describe the timing between menopause and the onset of symptomatic hand osteoarthritis (OA), and associations with the use of hormone replacement therapy (HRT) or its discontinuation, describing any identifiable subgroups of women.

Methods: Retrospective healthcare-records study of sequential women referred to a specialist hand OA clinic, 2007–2015. Confirmation of hand OA diagnosis was by clinican, by accepted criteria. Demographics and clinical variables were from healthcare-records, recorded by standardised proforma. Outcomes of interest were reported age of onset of hand symptoms, reported age at final menstrual period (FMP), time from FMP to reported onset of hand symptoms and time from cessation of HRT to reported onset of hand symptoms. Exposure categories for systemic HRT use were never users, current users, previous users. Analysis of Variance compared groups; linear regression analysed associations of exposure with outcome.

Results: 82/92(89%) of eligible women were post-menopausal, mean age at FMP 49.9 years (SD5.4). In these post-menopausal women, median time from FMP to hand symptom onset was 3 years. 48/82 (59%) developed hand symptoms within the defined peri-menopausal period (FMP ± 4 years), whilst some women developed their symptoms before or after (range −25, 30 years). In women who discontinued HRT prior to symptom onset, the median time from HRT cessation to onset of hand symptoms was 6 months. Past HRT users were older at hand symptom onset than women who had not taken HRT [coeff.4.7 years (0.92, 8.39); P = 0.015].

Conclusions: This study adds to evidence associating the menopause/sex hormone deficiency with hand OA symptom onset in a sizeable subgroup of women (but not all). HRT use/cessation appears to influence the timing of onset of hand OA symptoms. It is not possible to interpret from this type of study whether sex hormone deficiency is causative of disease or modulates its symptoms. It is also not possible to judge whether painful hand osteoarthritis in post-menopausal women is a subtype of disease. Further investigation is indicated of sex-specific subtypes and potential for personalised medicine for post-menopausal women with hand osteoarthritis, as a clearly definable high-risk subgroup.
Original languageEnglish
Article number1331187
Number of pages9
JournalFrontiers in Pain Research
Volume5
DOIs
Publication statusPublished - 12 Feb 2024

Bibliographical note

Funding Information: The author(s) declare financial support was received for the research, authorship, and/or publication of this article.

This work was supported by the Centre for Osteoarthritis Pathogenesis Versus Arthritis (grant numbers 20205 and 21621). FW is supported by a UKRI Future Leaders Fellowship (MR/S016538/1 and MR/S016538/2) and has also received support from Kennedy Trust for Rheumatology Research and the NIHR Oxford Biomedical Research Centre (BRC). MG is supported by a Versus Arthritis Clinical Research Fellowship (grant number 21604). FW is a member of the Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Oxford (grant number 21595). AJ was supported by the NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol. The funding sources had no involvement in the study design, collection, analysis or interpretation of data, or the decision to submit the article for publication. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

Publisher Copyright: © 2024 Gulati, Brewer, Judge, Kennedy, Vincent and Watt.

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