title: Effect of menopause on the modified Rodnan skin score in systemic sclerosis.
abstract: BACKGROUND
  We aimed to evaluate the effect of menopause on skin thickening, as measured by the modified Rodnan skin score (mRSS), in women with systemic sclerosis (SSc).
  
  
  METHODS
  We identified women with either limited or diffuse SSc, aged ≥ 18 years, enrolled within the Canadian Scleroderma Research Group (CSRG) cohort, between 2004 and 2011. As part of the CSRG cohort, subjects undergo annual assessments with standardized questionnaires and physical examinations. We performed multivariate regression analyses using generalized estimating equation (GEE) to determine the effect of menopause on the mRSS, adjusting for relevant covariates including notably age, follow-up time, and disease duration.
  
  
  RESULTS
  We identified 1070 women with SSc, contributing a total of 3546 observations over the study period. Of these women, at baseline, 65% had limited disease and 35% diffuse disease. In multivariate analyses, we observed a substantial effect of postmenopausal status on the mean mRSS in women with diffuse disease subtype [-2.62 units, 95% confidence interval (CI) -4.44, -0.80] and significant interaction between menopausal status and disease subtype (2.04 units, 95% CI 0.20, 3.88). The effect of postmenopausal status on the mean mRSS was smaller in women with limited SSc (-0.58, 95% CI -1.50, 0.34).
  
  
  CONCLUSIONS
  Our results suggest that menopause has a substantial effect on skin thickening in diffuse SSc, with postmenopausal status being associated with a lower mean mRSS compared to premenopausal status.
authors: Évelyne
authors: É
authors: Vinet
authors: Sasha
authors: S
authors: Bernatsky
authors: Marie
authors: M
authors: Hudson
authors: Christian A
authors: CA
authors: Pineau
authors: Murray
authors: M
authors: Baron
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003520:Cyclophosphamide / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D017698:Postmenopause; D017697:Premenopause; D012044:Regression Analysis; D012595:Scleroderma, Systemic / Q000188:drug therapy / Q000473:pathology*; D012867:Skin / Q000187:drug effects / Q000473:pathology*; D011795:Surveys and Questionnaires
chemical_list: D018501:Antirheumatic Agents; D003520:Cyclophosphamide