Could sex-specific subtypes of hand osteoarthritis exist? A retrospective study in women presenting to secondary care
Could sex-specific subtypes of hand osteoarthritis exist? A retrospective study in women presenting to secondary care
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DOI：
10.3389/fpain.2024.1331187
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发表时间：
2024-02
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通讯作者：
Malvika Gulati;Gretchen Brewer;Andrew Judge;Donna Kennedy;Tonia L. Vincent;Fiona E Watt
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作者：
Malvika Gulati;Gretchen Brewer;Andrew Judge;Donna Kennedy;Tonia L. Vincent;Fiona E Watt
手骨关节炎在女性中更常见，其风险在绝经期前后增加。我们描述了绝经期和症状性手骨关节炎（OA）发作之间的时间，以及与激素替代疗法（HRT）使用或停用的相关性，描述了任何可识别的女性亚组。方法对2007-2015年转诊至手部OA专科诊所的连续女性进行回顾性医疗记录研究。手OA的诊断由临床医生根据公认的标准进行确认。人口统计学和临床变量来自医疗记录，通过标准化形式记录。感兴趣的结果是报告的手部症状发作的年龄，报告的末次月经期（FMP）的年龄，从FMP到报告的手部症状发作的时间和从HRT停止到报告的手部症状发作的时间。全身HRT使用的暴露类别为从未使用者、当前使用者、既往使用者。方差分析比较各组;线性回归分析暴露与结果的相关性。结果82/92例（89%）符合条件的妇女为绝经后妇女，FMP时平均年龄为49.9岁（SD 5.4）。在这些绝经后妇女中，从FMP到手部症状发作的中位时间为3年。48/82（59%）在定义的围绝经期（FMP ± 4年）内出现手部症状，而一些女性在此之前或之后（范围-25，30年）出现症状。在症状发作前停止HRT的女性中，从HRT停止到手部症状发作的中位时间为6个月。既往HRT使用者手部症状发生年龄大于未使用HRT者[coeff.4.7岁（0.92，8.39）; P = 0.015]。结论这项研究增加了证据关联绝经/性激素缺乏症与手OA症状发作在一个相当大的妇女亚组（但不是全部）。HRT的使用/停止似乎会影响手部OA症状发作的时间。从这类研究中无法解释性激素缺乏是否是疾病的病因或调节其症状。也不可能判断绝经后妇女的疼痛性手骨关节炎是否是疾病的一个亚型。进一步的研究表明，绝经后女性手骨关节炎的性别特异性亚型和个性化药物的潜力，作为一个明确定义的高风险亚组。
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.