title: Influence of sex, age, and menopausal state on the course of early rheumatoid arthritis.
abstract: 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 studied. Sex, age, and menopausal state at baseline, and disease activity, radiographic joint destruction, and physical disability during 6 years of followup were assessed.
  
  
  RESULTS
  The Disease Activity Score (DAS) was significantly higher in female compared to male patients at any time point except at the time of inclusion. This was mainly due to postmenopausal patients. Radiographic joint destruction (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 thereafter. Older male patients showed worse RJD than younger male patients at all time points measured. Physical disability was significantly worse in female compared to male patients, as well as in postmenopausal compared to premenopausal patients, and older male compared to younger male patients. Stepwise 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 term between menopausal state and age best predicted higher RJD. Higher age and the interaction term between menopausal state and age best predicted Health Assessment Questionnaire (HAQ) score.
  
  
  CONCLUSIONS
  Higher age at presentation of RA leads to a more severe disease course in terms of DAS, RJD, and HAQ. Although female sex has a deteriorating effect on the DAS, the menopausal state is responsible for the major part of the differences in outcome between men and women. Postmenopausal state in early RA influences future disability and damage, especially in older patients.
authors.affiliation: Department of Rheumatology, University Medical Center Nijmegen, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Kuiper
authors.forename: A M
authors.initials: AM
authors.lastname: van Gestel
authors.forename: H L
authors.initials: HL
authors.lastname: Swinkels
authors.forename: T M
authors.initials: TM
authors.lastname: de Boo
authors.forename: J A
authors.initials: JA
authors.lastname: da Silva
authors.forename: P L
authors.initials: PL
authors.lastname: van Riel
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000453:epidemiology* / Q000473:pathology / Q000503:physiopathology; D015331:Cohort Studies; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D006801:Humans; D007596:Joints / Q000473:pathology; D008297:Male; D008593:Menopause; D008875:Middle Aged; D011446:Prospective Studies; D012044:Regression Analysis; D012720:Severity of Illness Index; D017678:Sex Distribution