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P58 Menopausal age and the effect of menopause on disease activity in SLE
  1. Esin Beste Yilmaz,
  2. Agneta Zickert,
  3. Iva Gunnarsson,
  4. Elisabet Svenungsson and
  5. Aleksandra Antovic
  1. Karolinska Institute, Dept. of Medicine Solna, Division of Rheumatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden

Abstract

Objective To investigate menopausal age in women with SLE and controls, and to assess if SLE-related measurements, blood lipid levels, and hs-CRP differed with menopausal status among SLE patients.

Methods In a cross-sectional study, we compared self-reported menopausal age between 200 well-characterized women with SLE and 118 population controls.

Within the SLE cohort (n=200), we identified 30 pre- and 30 post-menopausal women, individually matched for age ±3 years. Disease activity indices (SLAM, SLEDAI), damage (SLICC/ACR Damage Index (DI)), lipid profiles, and CRP were compared between the two groups.

Results 1) Age at menopause in SLE and controls . Mean age among SLE patients and controls was 59.2 (SD 9) and 61.1 (SD 7.7) years, respectively, median disease duration of SLE patients was 17.7 years. Menopause occurred at a younger age in SLE than in controls (48.1 vs 50.6 years, p<0.0001). Even younger menopausal age was reported in the sub-groups with lupus nephritis (46.7 years) and previous cyclophosphamide treatment (45.9 years, table 1).

2) Comparisons between pre- versus post-menopausal status among women with SLE. Mean ages in the matched pre- and post-menopausal groups were 44.4 and 44.9, respectively (p=0.7). Three post-menopausal and two pre-menopausal patients were on statin treatment. We observed no difference regarding disease activity, damage, or lipids between the groups, but hs-CRP was higher among pre-menopausal women. (6.1 vs. 2.7 mg/L, p=0.04, table 2).

Conclusions Women with SLE enter menopause earlier than women from the general population, regardless of lupus nephritis or cyclophosphamide exposure. However, both a diagnosis of lupus nephritis and previous cyclophosphamide treatment, are associated with even younger age at menopause.

Premenopausal women with SLE have similar disease activity, damage scores, and blood lipid levels but higher hs-CRP compared to postmenopausal SLE women of similar age. Our data indicate that menopausal status does not affect disease burden or the lipid profile in SLE patients.

Larger and longitudinal studies are needed to understand if the higher hs-CRP in postmenopausal patients is associated with a systemic inflammatory state and if the underlying mechanisms and effects of early menopause in women with SLE have effects over longer periods of time, not investigated here.

Acknowledgements Karolinska SLE Cohort has research funding and grants from the Swedish Research Council (2018–02535, 2022–00783), Swedish Heart-Lung Foundation (20200552), Stockholm County Council (ALF grant 20200075), The Swedish Society of Medicine, Ingegerd Johansson’s foundation (SLS-713911, SLS-936450), The King Gustaf V 80th Birthday Fund (grant no. FAI-2021–0794), the Swedish Rheumatism Association (R-981193).

Abstract P58 Table 1

Mean age at menopause and p values for comparison between all SLE patients and subgroups of SLE patients with population controls. The last column is a comparison between SLE subgroups and other SLE patients who did not belong to the investigated subgroup

Abstract P58 Table 2

Means with standard deviation or medians with interquartile range values (when applicable according to distribution) of SLAM, SLEDAI-2K, SLICC DI, total cholesterol, HDL, LDL, triglycerides, and hs-CRP for each group and p values for differences. (*p-value from non-parametric Wilcoxon test due to non-normal distribution of data) Reference values: Total cholesterol<5.2 mmol/L, LDL<2,6 mmol/L, HDL > 1,55 mmol/L, Triglycerides <1.7 mmol/L, hs-CRP<3,0 mg/L

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