Musculoskeletal pain and menopause

Social determinants and work-related musculoskeletal disorders in Brazil

This study aimed to analyze the prevalence of work-related musculoskeletal disorders (WMSD) and their association with individual and contextual factors in the Brazilian population. This quantitative cross-sectional study used secondary data from the Brazilian National Health Survey from August 2013 to February 2014. The dependent variable included WMSD, and independent variables were analyzed as individual and contextual factors. WMSD was mostly prevalent in females, individuals aged 43 to 59 years, with chronic physical or mental disorders, reporting frequent sleep disorders, and performing integrative and complementary health practices, physical exercise or sports, and heavy physical activity or housework. Regarding contextual factors, high social classes and proportion of individuals with formal work were associated with a high prevalence of WMSD, whereas a high Gini index was associated with a low prevalence. Thus, a high prevalence of WMSD in the Brazilian population was associated with individual and contextual factors, which should be the target of health professionals for actions of promotion, prevention, and intervention at individual or collective care levels.

Trajectories of chronic multimorbidity patterns in older patients: MTOP study

BACKGROUND

Multimorbidity is associated with negative results and poses difficulties in clinical management. New methodological approaches are emerging based on the hypothesis that chronic conditions are non-randomly associated forming multimorbidity patterns. However, there are few longitudinal studies of these patterns, which could allow for better preventive strategies and healthcare planning. The objective of the MTOP (Multimorbidity Trajectories in Older Patients) study is to identify patterns of chronic multimorbidity in a cohort of older patients and their progression and trajectories in the previous 10 years.

METHODS

A retrospective, observational study with a cohort of 3988 patients aged > 65 was conducted, including suspected and confirmed COVID-19 patients in the reference area of Parc Taulí University Hospital. Real-world data on socio-demographic and diagnostic variables were retrieved. Multimorbidity patterns of chronic conditions were identified with fuzzy c-means cluster analysis. Trajectories of each patient were established along three time points (baseline, 5 years before, 10 years before). Descriptive statistics were performed together with a stratification by sex and age group.

RESULTS

3988 patients aged over 65 were included (58.9% females). Patients with ≥ 2 chronic conditions changed from 73.6 to 98.3% in the 10-year range of the study. Six clusters of chronic multimorbidity were identified 10 years before baseline, whereas five clusters were identified at both 5 years before and at baseline. Three clusters were consistently identified in all time points (Metabolic and vascular disease, Musculoskeletal and chronic pain syndrome, Unspecific); three clusters were only present at the earliest time point (Male-predominant diseases, Minor conditions and sensory impairment, Lipid metabolism disorders) and two clusters emerged 5 years before baseline and remained (Heart diseases and Neurocognitive). Sex and age stratification showed different distribution in cluster prevalence and trajectories.

CONCLUSIONS

In a cohort of older patients, we were able to identify multimorbidity patterns of chronic conditions and describe their individual trajectories in the previous 10 years. Our results suggest that taking these trajectories into consideration might improve decisions in clinical management and healthcare planning.

TRIAL REGISTRATION NUMBER

NCT05717309.

Musculoskeletal pain among Chinese women during the menopausal transition: findings from a longitudinal cohort study

ABSTRACT

The profiles of muscle and joint pain throughout the menopausal transition and the factors associated with these symptoms have not been determined. A total of 609 participants from a longitudinal cohort study conducted in an urban Chinese community were enrolled in this study. We assessed the prevalence of musculoskeletal symptoms at different menopausal stages and explored the factors associated with these symptoms. The prevalence and severity of muscle and joint pain increase as menopausal stages progress, and late menopausal transition may be a crucial timepoint that triggers the onset of musculoskeletal pain. The results of the multivariate analysis revealed that poor health status (OR = 2.245, 95% CI = 1.714-2.94, P < 0.001), body mass index (BMI) (OR = 1.046, 95% CI = 1.01-1.084, P = 0.011), the presence of anxiety (OR = 1.601, 95% CI = 1.211-2.117, P < 0.001), and depression (OR = 1.368, 95% CI = 1.143-1.639, P < 0.001) were independently associated with muscle and joint pain. In addition, the severity of musculoskeletal pain was related to poor health status (OR = 2.738, 95% CI = 1.91-3.924, P < 0.001) and depression (OR = 1.371, 95% CI = 1.095-1.718, P = 0.006). Musculoskeletal symptoms are frequent somatic symptoms experienced by Chinese middle-aged women. Women with poor health status, high BMI, anxiety, and depression were at heightened risk of experiencing musculoskeletal pain. The severity of pain increased over time.

Associations between the severity of menopausal symptoms and musculoskeletal pain in postmenopausal Portuguese women

OBJECTIVE

To analyze the association of the severity of the menopausal symptoms with musculoskeletal pain in Portuguese postmenopausal women.

METHODS

A cross-sectional, observational study was conducted on 167 women (63.85 ± 9.36 years). The Menopause Rating Scale was used to evaluate the menopausal symptoms severity, while the Nordic Musculoskeletal Questionnaire was employed to assess the localization of the musculoskeletal pain, and multi-located pain was determined if two or more body regions were affected. Depression (Hospital Anxiety and Depression Scale), age, body mass index (BMI) and physical activity level were considered as potential confounders.

RESULTS

A greater severity of the somato-vegetative menopausal symptoms was related to the prevention from usual activities because of pain in the neck, shoulders, elbows, wrists/hands and knees (R2 of Nagelkerke = 0.064, 0.043, 0.074, 0.045 and 0.045, respectively). Associations were also observed between greater age and pain in the knees, ankles and feet (R2 of Nagelkerke = 0.036 and 0.034, respectively), and being physically inactive with upper back pain (R2 of Nagelkerke = 0.060). Higher depressive symptoms were linked to pain in the hip/thighs and knees (R2 of Nagelkerke = 0.067 and 0.085, respectively), as well as being physically inactive was related ton in the neck (R2 of Nagelkerke = 0.053). Only a greater BMI was related to multi-located pain in the last 7 days (R2 of Nagelkerke = 0.041).

CONCLUSIONS

The findings of our study showed that, taking into account possible confounders, greater severity of the menopausal symptoms at a somatic-vegetative level was associated with more anatomical regions with musculoskeletal pain.

Arthralgia in midlife Singaporean women: the Integrated Women's Health Program (IWHP)

OBJECTIVE

Arthralgia is a common menopausal complaint in midlife women, and its causes remain unclear. We examined the prevalence of menopausal arthralgia with various factors including sleep quality, depression/anxiety, muscle strength and physical performance among midlife Singaporean women.

METHODS

The Integrated Women's Health Program (IWHP) comprised 1120 healthy, community-dwelling women of Chinese, Malay or Indian ethnicities (aged 45-69 years) attending well-women clinics at the National University Hospital, Singapore. Sociodemographic, menopausal, reproductive and health data were obtained with validated questionnaires. Muscle strength, physical performance and dual-energy X-ray absorptiometry were measured. Women with moderate to very severe symptoms using the Menopause Rating Scale were classified as having arthralgia. Multivariable logistic regression analyses examined risk factors for arthralgia.

RESULTS

One-third of the participants reported arthralgia, and 12.7%, 16.2% and 71.2% were in the premenopausal, perimenopausal and postmenopausal period, respectively. Menopausal symptoms, such as vaginal dryness (adjusted odds ratio [aOR]: 2.64, 95% confidence interval [CI]: 1.64, 4.24) and physical/mental exhaustion (aOR: 2.83, 95% CI: 1.79, 4.47), were independent risk factors for arthralgia. Poor muscle strength (aOR: 2.20, 95% CI: 1.29, 3.76), obesity (aOR: 1.94, 95% CI: 1.13, 3.32) and rheumatoid arthritis (aOR: 7.73, 95% CI: 4.47, 13.36) were also independently associated with arthralgia after adjustment for confounders.

CONCLUSIONS

Arthralgia in midlife Singaporean women was associated with menopausal symptoms of vaginal dryness and physical and mental exhaustion. Women with poor muscle strength were more likely to experience menopausal arthralgia.

Orofacial Pain and Risk of Dysphagia in Women With Fibromyalgia: A Cross-Sectional Observational Study

OBJECTIVE

This study aims to analyze the frequency of dysphagia risk and swallowing-associated quality of life (QoL) in a sample of women with fibromyalgia syndrome (FMS) and examine the potential relationship between risk of dysphagia and chronic orofacial pain (COP) in a sample of women with FMS.

METHOD

A cross-sectional observational study was conducted in 46 women with FMS. COP was assessed by mouth opening, the orofacial visual analog scale (VAS), and the craniofacial pain and disability inventory (CF-PDI). Risk of dysphagia was assessed using the Eating Assessment Tool (EAT-10) and the volume-viscosity swallowing test (V-VST). Swallowing-associated QoL was determined using the Swallowing Quality of Life (SWAL-QOL) questionnaire.

RESULTS

Thirty patients were identified as being at risk for dysphagia (65.21%) using the EAT-10 and, according to the SWAL-QOL, 41.30% of patients had alterations in QoL associated with swallowing. The EAT-10 correlated positively with orofacial VAS, CF-PDI-total, CF-PDI-pain and disability, and CF-PDI-jaw-functional status. In relation to SWAL-QOL, negative correlations were observed for orofacial VAS, CF-PDI-total, CF-PDI-pain and disability, and CF-PDI-jaw-functional status. Patients at risk of dysphagia (EAT-10 and V-VST) had significantly higher scores in orofacial VAS (p = .002 and p = .015), CF-PDI-total (p = .006 and p = .014), and CF-PDI-pain and disability (p = .004 and p = .013).

CONCLUSIONS

In this sample of women with FMS, we identified a high rate of dysphagia risk. Also, a high percentage of these women presented alterations in QoL associated with swallowing. Patients at risk for dysphagia had significantly higher orofacial VAS and CF-PDI-total scores, supporting the relationship between dysphagia risk and COP in FMS. Further research to establish the need for appropriate assessment referrals in clinical practice to determine whether dysphagia is present in this population is needed.

Long chain n-3 polyunsaturated fatty acid intake across the life span for cardiovascular disease prevention in women

Cardiovascular diseases (CVDs) are a major health concern for women. Historically there has been a misconception that men are at greater risk because CVD tends to occur earlier in life compared to women. Clinical guidelines for prevention of heart disease are currently the same for both sexes, but accumulating evidence demonstrates that risk profiles diverge. In fact, several CVD risk factors confer an even greater risk in women relative to men, including high blood pressure, obesity, diabetes and raised triglycerides. Furthermore, many female-specific CVD risk factors exist, including early menarche, pregnancy complications, polycystic ovary syndrome, reproductive hormonal treatments and menopause. Little is known about how diet interacts with CVD risk factors at various stages of a woman’s life. Long chain (LC) n-3 polyunsaturated fatty acid (PUFA) intakes are a key dietary factor that may impact risk of CVD throughout the life course differentially in men and women. Oestrogen enhances conversion of the plant n-3 PUFA, alpha-linolenic acid, to LCn-3 PUFA. Increasing the frequency of oily fish consumption or LCn-3 PUFA supplementation may be important for reducing coronary risk during the menopausal transition, during which time oestrogen levels decline and the increase in CVD risk factors is accelerated. Women are under-represented in the evidence base for CVD prevention following LC n-3 PUFA supplementation. Therefore it is not clear whether there are sex differences in response to treatment. Furthermore, there is a lack of evidence on optimal intakes of LC n-3 PUFA across the lifespan for CVD prevention in women.

Comprehensive reproductive healthcare for women with immune-mediated inflammatory diseases: Addressing rheumatoid arthritis, spondyloarthritis and inflammatory bowel disease through life's stages

Immuno-mediated inflammatory diseases (IMIDs) such as rheumatoid arthritis, spondyloarthritis, and inflammatory bowel disease are characterised by pathophysiological mechanisms wherein the immune system erroneously targets the body's own tissues. This review explores the heightened vulnerability of women with IMIDs, influenced by hormonal modulators like estrogen and progesterone. The challenges this poses are multifaceted, encompassing the impact of active disease and medical treatments throughout life stages, including family planning, fertility, and menopause. From the perspectives of rheumatologists and gastroenterologists, we review current management strategies and underscore the need for a multidisciplinary and life-cycle approach to healthcare for women with IMIDs.

Nutritional Aspects, Chemistry Profile, Extraction Techniques of Lemongrass Essential Oil and It's Physiological Benefits

Lemongrass contains a variety of substances that are known to have antioxidant and disease-preventing properties, including essential oils, compounds, minerals, and vitamins. Lemongrass (Cymbopogon Spp.) essential oil (LGEO) has been demonstrated to ameliorate diabetes and accelerate wound healing. A member of the Poaceae family, Lemongrass, a fragrant plant, is cultivated for the extraction of essential oils including myrcene and a mixture of geranial and neral isomers of citral monoterpenes. Active constituents in lemongrass essential oil are myrcene, followed by limonene and citral along with geraniol, citronellol, geranyl acetate, neral, and nerol, which are beneficial to human health. A large part of lemongrass' expansion is driven by the plant's huge industrial potential in the food, cosmetics, and medicinal sectors. A great deal of experimental and modeling study was conducted on the extraction of essential oils. Using Google Scholar and PubMed databases, a systematic review of the literature covering the period from 1996 to 2022 was conducted, in accordance with the PRISMA declaration. There were articles on chemistry, biosynthesis, extraction techniques and worldwide demand of lemongrass oil. We compared the effectiveness of several methods of extracting lemongrass essential oil, including solvent extraction, supercritical CO2 extraction, steam distillation, hydrodistillation (HD), and microwave aided hydrodistillation (MAHD). Moreover, essential oils found in lemongrass and its bioactivities have a significant impact on human health. This manuscript demonstrates the different extraction techniques of lemongrass essential oil and its physiological benefits on diabetic wound healing, tissue repair and regeneration, as well as its immense contribution in ameliorating arthritis and joint pain.Key teaching pointsThe international market demand prediction and the pharmacological benefits of the Lemongrass essential oil have been thoroughly reported here.This article points out that different extraction techniques yield different percentages of citral and other secondary metabolites from lemon grass, for example, microwave assisted hydrodistillation and supercritical carbon dioxide extraction process yields more citral.This article highlights the concept and application of lemongrass oil in aromatherapy, joint-pain, and arthritis.Moreover, this manuscript includes a discussion about the effect of lemongrass oil on diabetic wound healing and tissue regeneration - that paves the way for further research.

Quantitative sensory testing, psychological profiles and clinical pain in patients with psoriatic arthritis and hand osteoarthritis experiencing pain of at least moderate intensity

BACKGROUND

Chronic pain is the hallmark symptom of joint diseases. This study examined the differences in quantitative sensory testing between patients with psoriatic arthritis (PsA), hand osteoarthritis (hand-OA) and a pain-free control group and differences between patients with and without concomitant fibromyalgia (cFM).

METHODS

All patients and pain-free controls were assessed using pressure pain thresholds (PPT), temporal summation of pain (TSP), conditioned pain modulation (CPM) and clinical pain intensities. Psychological distress was assessed with the Hospital Anxiety and Depression Scale, Pain Catastrophizing Scale, and Pittsburgh Sleep Quality Index. Disability was assessed with the Health Assessment Questionnaire and pain quality with the painDETECT questionnaire. cFM was identified using the revised 2016 American College of Rheumatology diagnostic criteria.

RESULTS

Patients with hand-OA (n = 75) or PsA (n = 58) had statistically significant lower PPTs and CPM, greater TSP, and higher scores of psychological distress (p < 0.05) than controls (n = 20). Patients with cFM (58%) had higher scores of depression (p = 0.001), anxiety (p = 0.004), catastrophizing (p = 0.012), disability (p < 0.001), higher painDETECT score (p = 0.001), TSP (p = 0.027), and reduced sleep quality (p = 0.021) when compared to patients without cFM.

CONCLUSION

Patients with hand-OA and PsA exhibited signs of pain sensitization and a higher degree of psychological distress and disability than pain-free individuals. Patients with cFM had greater TSP, painDETECT score, disability, catastrophizing, and reduced sleep quality, than patients without, indicating greater degree of pain sensitization, psychological burden, and disability.

STATEMENT OF SIGNIFICANCE

This paper shows that a significant proportion of patients with hand osteoarthritis and psoriatic arthritis with moderate pain intensity have significantly increased signs of pain sensitization and markers of psychological distress. A large proportion of these patients fulfil the criteria for concomitant fibromyalgia and these patients show even greater propensity towards pain sensitization and psychological distress.

Perceptions of pain in aging females undergoing spinal cord stimulation

Aim: Effects of age and sex on chronic pain outcomes following spinal cord stimulation (SCS) have not yet been assessed. Methods: We retrospectively reviewed 1 year outcomes from a database of patients receiving thoracic SCS. Subjects were divided into four cohorts: pre-menopausal and post-menopausal females, and aged-matched males. Improvement using the numerical rating scale, Oswestry Disability Index (ODI), Beck's Depression Inventory (BDI), McGill Pain Questionnaire and Pain Catastrophizing Scale (PCS) was assessed. Results: Older females were notably different from males and females under 60 as they had greater improvements in ODI, BDI and PCS. Further, females ≥60 had greater improvement in PCS compared with males ≥60. Conclusion: Our findings suggest greater improvement with 1 year SCS treatment in post-menopausal females, compared with age-matched males.

Serum VEGF and CGRP Biomarkers: Relationships with Pain Intensity, Electric Pain, Pressure Pain Threshold, and Clinical Symptoms in Fibromyalgia-An Observational Study

Fibromyalgia (FM) is a multifactorial syndrome, mainly characterized by chronic widespread pain, whose physiopathology is yet to be determined. Reliable biomarkers for FM and how they are associated with the symptomatology have not yet been identified. We aimed to examine the relationships among serum vascular endothelial growth factor (VEGF) and calcitonin gene-related peptide (CGRP) levels with clinical manifestations and pain-related variables in women with FM. We conducted an observational case study with forty-seven women diagnosed with FM. Serum VEGF and CGRP levels were spectrophotometrically analyzed. We used questionnaires to measure the impact of FM and the degree of central sensitization, fatigue, and anxiety. We also assessed pain intensity, electric pain threshold and magnitude, and pressure pain threshold (PPT) in tender points. The linear regression analysis adjusting for age, menopause status, and body mass index showed that serum VEGF levels were significantly associated with the PPTs of non-dominant trapezius (β = 153.418; p = 0.033), non-dominant second metacarpal (β = 174.676; p = 0.008) and dominant tibialis anterior (β = 115.080; p = 0.049) in women with FM. We found no association between serum CGRP levels and the variables measured (p ≥ 0.152). Our results suggest that VEGF may be related to pain processing in patients with FM.

The influence of sex hormones on musculoskeletal pain and osteoarthritis

The association of female sex with certain rheumatic symptoms and diseases is now indisputable. Some of the most striking examples of this association occur in individuals with musculoskeletal pain and osteoarthritis, in whom sex-dependent changes in incidence and prevalence of disease are seen throughout the lifecourse. Joint and muscle pain are some of the most common symptoms of menopause, and there is increasingly compelling evidence that changes in or loss of sex hormones (be it natural, autoimmune, pharmacological, or surgical) influence musculoskeletal pain propensity and perhaps disease. However, the effects of modulation or replacement of sex hormones in this context are far less established, particularly whether these approaches could represent a preventative or therapeutic opportunity once symptoms have developed. In this Review, we present evidence for the association of changes in sex hormones with musculoskeletal pain and painful osteoarthritis, discussing data from diverse natural, therapeutic, and experimental settings in humans and relevant animal models relating to hormone loss or replacement and the consequent effects on health, pain, and disease. We also postulate mechanisms by which sex hormones could mediate these effects. Further research is needed; however, increased scientific understanding of this complex area could lead to real benefits in musculoskeletal and women's health.

The role of diet in managing menopausal symptoms: A narrative review

Menopause is a natural stage that occurs when women stop menstruating, during which many women experience physical and psychological symptoms that can affect their quality of life and ability to work. Dietary modifications and food supplements may be explored by some women as alternatives to hormone replacement therapy, although existing reviews and expert position statements have given this limited consideration. This narrative review summarises the current evidence for dietary patterns, and botanical and food supplements, in the management of common menopausal symptoms, including vasomotor symptoms (VMS; hot flushes; night sweats), changes in bodyweight and composition, psychological symptoms (depression; anxiety; cognitive changes), sleep disturbances, joint pain, skin changes and urogenital symptoms. Soy isoflavones may reduce the frequency and/or severity of VMS, although results are inconsistent, and it is unclear whether dietary and supplemental sources have comparable effects. Adopting a healthier dietary pattern may support a healthy bodyweight and benefit VMS. However, evidence suggesting dietary patterns may benefit depression, anxiety, and cognition remains largely observational. While some botanicals, such as black cohosh and St John's Wort, have been reported in some studies to alleviate symptoms (such as VMS and depression), these are not currently recommended due to uncertainty about the appropriate dose and preparation, and potential safety concerns. Evidence for other symptoms is currently too limited to draw conclusions. While further trials at different menopausal stages are needed, adopting a healthier dietary pattern in accordance with dietary guidelines is likely to help support women's health before, during and after the menopausal transition.

Transcultural adaptation and validation of the Spanish version of the Global Pain Scale

The aim of this study was to perform a cross-cultural adaption and validation of the Global Pain Scale (GPS) to produce a Spanish-language version (GPS-Sp) and to determine the psychometric properties of this instrument. The GPS was cross-culturally translated into Spanish following the guidelines of the International Society for Pharmacoeconomics and Outcomes Research. The initial study population was composed of 384 patients recruited from February to May 2021. All participants were aged at least 18 years and were currently experiencing pain. All gave signed informed consent to take part and completed the Brief Inventory-Sp and GPS-Spain questionnaires. Cronbach's ɑ and test/retest reliability values were calculated and floor/ceiling effects analyzed. Construct validity was assessed by confirmatory factor analysis (CFA). The 370 patients included in the final analysis presented the following characteristics: 36.2% were male and 63.8% were female; mean age 42.6 (19-88) years; mean body mass index 24.99. Internal consistency was good. The Cronbach's ɑ for GPS-Sp was 0.86 and the intraclass correlation coefficient was 0.94 (95% CI; 0.87-0.97). Five main explanatory factors were identified by CFA, which produced the following values: RMSEA = 0.057; CFI = 0.807; GFI = 0.809; NFI = 0.763. No floor/ceiling effect was observed. The GPS-Sp is a valid, reliable and sensitive instrument for assessing pain in a Spanish-speaking population and could facilitate pain relief in this population.

The effect of Cornus mas fruit extract on vasomotor symptoms and sex hormones in postmenopausal women: a randomized, double-blind, clinical trial

OBJECTIVES

Cornus mas fruit has various antioxidants and anti-inflammatory properties, so this study aims at assessing its effect on menopausal symptoms and sex hormones in postmenopausal women.

METHODS

In the current randomized, double-blind clinical trial, 84 individuals (42 per group) were participated. C mas hydroalcoholic extract was prepared, and participants received 300 mg C mas extract or placebo three times a day (900 g in total) for 8 weeks. The demographic, dietary intake, and physical activity information were gathered. Anthropometric indices were measured by standard methods. Furthermore, menopause symptoms were assessed by Greene Climacteric Scale. Also, sex hormones were measured by enzyme-linked immunosorbent assay.

RESULTS

Based on the results, there was a significant difference in total Greene score reduction between the intervention and placebo groups (-3.19 ± 0.54, -0.76 ± 0.32, and P < 0.001). In addition, vasomotor symptoms had a remarkable decrease in the C mas extract group (P < 0.001). Also, the intervention group demonstrated a decreasing trend in the number and duration of hot flushes. Moreover, follicle-stimulating hormone remarkably decreased and estradiol increased in the intervention group (P = 0.016 and P = 0.018).

CONCLUSIONS

It has been found that the extract of C mas fruit has a favorable effect on vasomotor symptoms, sex hormones, and related complications in women experiencing menopausal symptoms.

Associations among serum VEGF and CGRP levels with the peripheral vascular blood flow of the skin of the hands in women with Fibromyalgia

BACKGROUND

Fibromyalgia (FM) is a long-term condition of unknown physiopathology, whose hallmark symptoms are diffuse musculoskeletal chronic pain and fatigue.

OBJECTIVES

We aimed to analyze the associations among serum vascular endothelial growth factor (VEGF) and calcitonin gene-related peptide (CGRP) levels with the peripheral temperature of the skin of both hands and the core body temperature in patients with FM and healthy controls.

METHODS

We conducted a case-control observational study with fifty-three women diagnosed with FM and twenty-four healthy women. VEGF and CGRP levels were spectrophotometrically analyzed in serum by enzyme-linked immunosorbent assay. We used an infrared thermography camera to assess the peripheral temperature of the skin of the dorsal thumb, index, middle, ring, and pinkie fingertips and dorsal centre as well as the palm thumb, index, middle, ring, and pinkie fingertips, palm centre and thenar and hypothenar eminences of both hands and an infrared thermographic scanner to record the tympanic membrane and axillary temperature.

RESULTS

Linear regression analysis adjusting for age, menopause status, and body mass index showed that serum VEGF levels were positively associated with the maximum (β = 65.942, 95% CI [4.100,127.784], p = 0.037), minimum (β = 59.216, 95% CI [1.455,116.976], p = 0.045), and mean (β = 66.923, 95% CI [3.142,130.705], p = 0.040) temperature of the thenar eminence of the non-dominant hand, as well as with the maximum temperature of the hypothenar eminence of the non-dominant hand (β = 63.607, 95% CI [3.468,123.747], p = 0.039) in women diagnosed with FM.

CONCLUSIONS

Mild associations were observed between serum VEGF levels and the peripheral temperature of the skin in hand areas in patients with FM; therefore, it is not possible to establish a clear relationship between this vasoactive molecule and vasodilation of the hands in these patients.

Priorities for alleviating menopausal symptoms after cancer

OBJECTIVE

To determine treatment priorities in women cancer patients attending a dedicated Menopausal Symptoms After Cancer service.

METHODS

Cancer type and stage were abstracted from medical records. Women ranked up to three symptoms as treatment priorities from the list "hot flushes/night sweats," "mood changes," "vaginal dryness or soreness," "sleep disturbances," "feeling tired or worn out (fatigue)," "sexual problems and/or pain with intercourse," "joint pain," and "something else" with free-text response. For each prioritized symptom, patients completed standardized patient-reported outcome measures to determine symptom severity and impact.

RESULTS

Of 189 patients, most had breast cancer (48.7%, n = 92), followed by hematological (25.8%, n = 49), gynecological (18.0%, n = 34), or colorectal (2.6%, n = 5). The highest (first-ranked) treatment priority was vasomotor symptoms (33.9%, n = 64), followed by fatigue (18.0%, n = 34), vaginal dryness/soreness (9.5%, n = 18), and sexual problems/pain with intercourse (9.5%, n = 18). Symptoms most often selected in the top three ("prioritized") were fatigue (57.7%, n = 109), vasomotor symptoms (57.1%, n = 108), and sleep disturbance (49.2%, n = 93). In patients who prioritized vasomotor symptoms, medians on the "problem," "distress," and "interference" dimensions of the Hot Flash Related Daily Interference Scale were, respectively, 6.0 (interquartile range [IQR], 5.0-8.0), 5.5 (IQR, 3.0-8.0), and 5.0 (IQR, 3.-7.0), indicating moderate severity. In patients who prioritized fatigue, the median Fatigue Scale score was 28 (IQR, 19-36), 37% worse than general population.

CONCLUSIONS

Vasomotor symptoms, fatigue, sexual problems, and vaginal dryness/soreness were the leading priorities for treatment. Understanding symptom severity and patient priorities will inform better care for this growing population.

Female reproductive status and exogenous sex hormone use in rheumatoid arthritis patients treated with tocilizumab and csDMARDs

OBJECTIVES

Sex is well known to influence risk, severity and treatment outcomes of RA, although the underlying causes are uncertain. The aim of this research was to examine whether factors influencing female sex hormones (reproductive status and exogenous sex hormone use) are associated with the efficacy of DMARDs.

METHODS

Individual participant data were pooled from five phase 3 clinical trials where RA patients were treated with tocilizumab and/or conventional synthetic DMARDs. The primary outcome was the time to first remission according to the Simplified Disease Activity Index. The relationship between menopausal status or use of exogenous sex hormones and the time of first remission was assessed via Cox proportional analysis. Analysed data included sex, baseline menopausal status (premenopausal, perimenopausal, early postmenopausal and postmenopausal), participant age, body mass index, race, number of previous DMARDs and baseline disease activity.

RESULTS

Analysis included 4474 female patients, of whom 2817 (62.9%) were postmenopausal, 202 (4.5%) were early postmenopausal, 1021 (22.8%) were premenopausal and 414 (9.2%) were perimenopausal. Of these, 221 (7.8%), 13 (6.4%), 255 (25%) and 47 (11.4%), respectively, were taking exogenous sex hormones. In the pooled analysis, perimenopausal status was associated with reduced remission compared with premenopausal status [adjusted HR 0.78 (95% CI 0.61, 0.99)]. Sex hormone use was associated with significantly higher remission [adjusted HR 1.20 (95% CI 1.01, 1.43)].

CONCLUSION

Perimenopausal women were less likely to achieve remission compared with premenopausal RA patients. The use of exogenous sex hormones appeared to be associated with more frequent remission in female RA patients, particularly those who were perimenopausal and early postmenopausal, although further research is required to confirm and identify the drivers for this observation and how it interacts with menopausal status.

The Role of Sex Hormones in Pain-Related Conditions

Millions of people are affected by pain-related conditions worldwide. Literature has consistently shown that each individual experiences and perceives pain in a unique manner due to biological, environmental, and cultural factors in which they have been raised. It has been established that biological males and females perceive pain differently and that it may be partially explained by their distinct hormonal profiles since birth, which are only further magnified during puberty. For biological males, high levels of testosterone have shown to increase their pain threshold; and for biological females, estrogen fluctuations have shown to increase pain intensity and perception. However, sex hormones have not been studied in the context of pain treatment or their impact on biochemical pathways involved in pain perception. For this purpose, the transgender community serves as a unique population to investigate the impact of hormone replacement therapy on molecular pathways involved in the perception of pain. The purpose of this review is to explore the biochemistry of hormone replacement in transgender patients who also have other pain-related conditions such as headaches, fibromyalgia, temporomandibular myalgia, and visceral pain.

Increased Clinical Pain Locations and Pain Sensitivity in Women After Breast Cancer Surgery: Influence of Aromatase Inhibitor Therapy

OBJECTIVES

Aromatase inhibitors (AIs), which potently inhibit estrogen biosynthesis, are a standard treatment for hormone sensitive early-stage breast cancer. AIs have been associated with substantial joint pain and muscle stiffness (aromatase inhibitor-associated musculoskeletal syndrome). However, the link between AIs and number of clinical pain locations and pain sensitivity are less well understood. The aim of this study was to compare longitudinal changes in clinical pain and quantitative pain sensitivity between women who did or did not receive AI therapy.

METHODS

Women with early-stage breast cancer were prospectively enrolled and assessed for clinical pain in surgical and nonsurgical body areas using the Brief Pain Inventory and Breast Cancer Pain Questionnaire, and for pain sensitivity using quantitative sensory testing preoperatively and at 1 year postoperatively. Pain outcomes between participants who did and did not begin adjuvant AI therapy were compared using Wilcoxon Signed-Ranks and generalized estimating equation linear regression analyses.

RESULTS

Clinical pain and pain sensitivity were comparable between AI (n=49) and no-AI (n=106) groups preoperatively. After adjusting for body mass index, AI therapy was associated with a greater increase in the number of painful nonsurgical body sites (significant time by treatment interaction, P =0.024). Pain location was most frequent in knees (28%), lower back (26%), and ankles/feet (17%). Quantitative sensory testing revealed a significant decrease in pain sensitivity (increased pressure pain threshold) in the no-AI group over time, but not in the AI group.

CONCLUSIONS

AI therapy was associated with increased diffuse joint-related pain and greater post-treatment pain sensitivity, potentially implicating central sensitization as a contributing pain mechanism of aromatase inhibitor-associated musculoskeletal syndrome worthy of future investigation.

Association of climacterium with temporomandibular disorders at the age of 46 years – a cross-sectional study

OBJECTIVE

Hormonal factors have been suggested to contribute to female dominance among subjects with temporomandibular disorders (TMD). Aim of the study was to examine the association of climacteric status with TMD amongst female participants in the Northern Finland Birth Cohort (NFBC) 1966 at 46 years of age.

MATERIAL AND METHODS

Among female subjects in NFBC1966, climacteric status was determined based on menstrual anamnesis and measurement of blood follicle-stimulating hormone (FSH) levels. Women with FSH > 25 IU/L and amenorrhoea > 4 months were defined as climacteric (case group, n = 71); women not diagnosed as climacteric were defined as preclimacteric (control group, n = 656). Differences between cases and controls were evaluated on self-reported TMD pain, clinical TMD signs and TMD diagnoses using modified Diagnostic Criteria for TMD (DC/TMD) protocol. Crosstabulation and logistic regression models were used to analyse differences between cases and controls.

RESULTS

Compared to preclimacteric women, climacteric women had significantly more often pain on palpation in temporomandibular joints (TMJs) (OR = 2.64, 95% CI 1.12-6.21, p= .026) and more crepitus in TMJs (OR = 2.92, 95% CI 1.13-7.56, p= .027). Degenerative joint disease diagnoses were more common in climacteric than preclimacteric women (OR = 2.27, 95% CI 1.05-4.91, p= .037). Differences were statistically significant after adjusting for confounding factors (body mass index (BMI), smoking, parity). No statistically significant differences in self-reported TMD pain were noted between groups.

CONCLUSION

Among females at the age of 46 years, climacterium seems associated with TMD by increasing pain on palpation in TMJs, subjective symptoms, and clinical signs indicating degenerative changes in TMJs when using DC/TMD.

Frailty-Diagnostik in verschiedenen AINS-Settings

Das Vorliegen eines sog. Frailty-Syndroms („Gebrechlichkeit“) ist für den postoperativen Verlauf ein entscheidender Faktor. So kommt es, auch durch eine zunehmende Fokussierung auf die patientenzentrierte Versorgung, zu einer erhöhten Nachfrage nach Instrumenten, die den Patient*innenstatus umfassender beurteilen und Krankheitsverläufe vorhersagen können. Der Beitrag stellt die 3 führenden Modelle zur Frailty-Diagnostik vor.

Hormone replacement therapy (conjugated oestrogens plus bazedoxifene) for post-menopausal women with symptomatic hand osteoarthritis: primary report from the HOPE-e randomised, placebo-controlled, feasibility study

Background

Symptomatic hand osteoarthritis is more common in women than in men, and its incidence increases around the age of menopause, implicating oestrogen deficiency. No randomised controlled trials of hormone replacement therapy (HRT) have been done in people with hand osteoarthritis. We aimed to determine the feasibility and acceptability of a form of HRT (conjugated oestrogens plus bazedoxifene) in post-menopausal women with painful hand osteoarthritis.

Methods

The HOPE-e feasibility study was a randomised, double-blind, placebo-controlled trial, for which we recruited women aged 40-65 years, for whom 1-10 years had passed after their final menstrual period, with definite hand osteoarthritis and at least two painful hand joints. Participants were recruited across three primary or secondary care sites and from the community and were randomly assigned (1:1) to receive conjugated oestrogens plus bazedoxifene or placebo, orally once every day for 24 weeks, before weaning for 4 weeks until the end of the study. The primary feasibility outcomes were rates of identification, recruitment, randomisation, retention, and compliance of eligible participants, and the likelihood of unmasking. The secondary objective was to generate proof-of-concept quantitative and qualitative data on the acceptability of proposed clinical outcomes for a full trial and adverse events. We used an intention-to-treat analysis, and criteria for progression to a full trial were pre-defined as recruitment of at least 30 participants across all sites in 18 months; a dropout rate of less than or equal to 30% of randomised individuals; and acceptability to the majority of participants, including acceptable rates of adverse events. Due to the COVID-19 pandemic, the recruitment window was reduced to 12-15 months. A proportionately reduced minimum sample size of 22 was judged to be sufficient to test feasibility. This trial was registered at ISRCTN, ISRCTN12196200.

Findings

From May 9, 2019 to Dec 31, 2020, 434 enquiries or referrals were received. We did 96 telephone pre-screens; of the 35 eligible participants, seven were excluded as ineligible at the telephone or face-to-face screening and 28 (80% [95% CI 63-92]) were randomly assigned. Of the 406 who were not randomly assigned, 250 (62%) were ineligible (with contraindicated medications accounting for 50 [20%] of these), 101 (25%) did not respond to further enquiries, and 55 (14%) chose not to proceed (with the most common reason being not wanting to take a hormone-based drug). All 28 randomised participants completed all follow-up assessments with high compliance and outcome measure completeness. All three adverse event-related treatment withdrawals were in the placebo group. No serious adverse events were reported. Participants and investigators were successfully masked (participant Bang's blinding index placebo group 0·50 [95% CI 0·25-0·75]). The trial met the prespecified criteria for progression to a full trial.

Interpretation

This first-ever feasibility study of a randomised controlled trial of HRT for post-menopausal women with painful hand osteoarthritis met its progression criteria, although it was not powered to detect a clinical effect. This outcome indicates that a full trial of an HRT in this population is feasible and acceptable and identifies potential refinements with regard to the design of such a trial.

Funding

Research for Patient Benefit programme, National Institute for Health Research.

Global burden of musculoskeletal disorders and attributable factors in 204 countries and territories: a secondary analysis of the Global Burden of Disease 2019 study

OBJECTIVE

To evaluate the global burden of musculoskeletal (MSK) disorders, as well as the five common conditions, and their relevant risk factors from 1990 to 2019.

DESIGN

Data from the Global Burden of Disease Study 2019 were used in this study.

SETTING AND PARTICIPANTS

Individuals of all ages and genders from 204 countries and territories in 21 regions.

MAIN OUTCOME MEASURES

The outcomes were the numbers and age-standardised rates (ASRs) of incident cases, deaths and disability-adjusted life-years (DALYs) of MSK disorders. The average annual percent changes (AAPCs) in the ASRs were calculated using joinpoint regression analysis to estimate the trends.

RESULTS

There were 322.75 million incident cases, 117.54 thousand deaths and 150.08 million DALYs of MSK disorders in 2019. The age-standardised incidence rate and age-standardised DALY rate in 2019 (incidence: AAPC=-0.32, 95% CI -0.34 to -0.31; DALYs: AAPC=-0.05, 95% CI -0.06 to -0.04) were lower than those in 1990. However, the age-standardised death rate showed a stable trend (AAPC 0.05, 95% CI -0.05 to 0.15) from 1990 to 2019. The peak age of onset and DALYs of MSK disorders was 50-54 years in 2019. The burden of MSK disorders in females was much higher than that in males (1.29 times more incident cases, 2.24 times more deaths and 1.45 times more DALYs in females than in males). A significant negative correlation was observed between the AAPCs in the ASRs and the Sociodemographic Index (SDI) score. Occupational risk exhibited the highest contribution to MSK disorders, and tobacco use and high body mass index were also major risk factors.

CONCLUSIONS

This study demonstrates that the burden of MSK disorders tends to be lower in high-SDI regions than in lower-SDI regions. Strengthening the effectiveness of preventive measures against occupational risks may reduce the burden of MSK disorders.

Endogenous estrogen deficiency and the development of chronic musculoskeletal pain: A review

Sexual dimorphism of chronic diseases is a phenomenon determined by differences in the hormonal status of men and women. In this regard, estrogens, which have a complex effect on the body, are of great interest. In particular, estrogens play an important role in the natural control of pain and inflammation. A decrease in estrogen levels associated with menopause or iatrogenic effects (hysterectomy, use of aromotase inhibitors), as well as mutations of genes responsible for the synthesis of structural components of membrane estrogen receptors (ESR1 and ESR2), can significantly reduce the positive effects of these hormones. Deficiency of estrogen can become one of the reasons for the development of serious pathological changes in particular, the formation of chronic pain associated with the pathology of the musculoskeletal system.

Estrogenic impregnation alters pain expression: analysis through functional neuropeptidomics in a surgical rat model of osteoarthritis

PURPOSE

Several observational studies suggest that estrogens could bias pain perception. To evaluate the influence of estrogenic impregnation on pain expression, a prospective, randomized, controlled, blinded study was conducted in a Sprague-Dawley rat model of surgically induced osteoarthritis (OA).

METHODS

Female rats were ovariectomized and pre-emptive 17β-estradiol (0.025 mg, 90-day release time) or placebo pellets were installed subcutaneously during the OVX procedures. Thirty-five days after, OA was surgically induced on both 17β-estradiol (OA-E) and placebo (OA-P) groups. Mechanical hypersensitivity was assessed by static weight-bearing (SWB) and paw withdrawal threshold (PWT) tests. Mass spectrometry coupled with high-performance liquid chromatography (HPLC-MS) was performed to quantify the spinal pronociceptive neuropeptides substance P (SP), calcitonin gene-related peptide (CGRP), bradykinin (BK), somatostatin (SST), and dynorphin-A (Dyn-A).

RESULTS

Compared to control, ovariectomized rats presented higher SP (P = 0.009) and CGRP (P = 0.017) concentrations. OA induction increased the spinal level of SP (+ 33%, P < 0.020) and decreased the release of BK (- 20%, (P < 0.037)). The OA-E rats at functional assessment put more % body weight on the affected hind limb than OA-P rats at D7 (P = 0.027) and D56 (P = 0.033), and showed higher PWT at D56 (P = 0.009), suggesting an analgesic and anti-allodynic effect of 17β-estradiol. Interestingly, the 17β-estradiol treatment counteracted the increase of spinal concentration of Dyn-A (P < 0.016) and CGRP (P < 0.018).

CONCLUSION

These results clearly indicate that 17β-estradiol interfers with the development of central sensitization and confirm that gender dimorphism should be considered when looking at pain evaluation.

Central Obesity in Axial Spondyloarthritis: The Missing Link to Understanding Worse Outcomes in Women?

OBJECTIVE

To determine (1) the prevalence of central obesity in axial spondyloarthritis (axSpA) and its effect on disease-related outcomes and (2) how this differs between sexes.

METHODS

Data were extracted from the Ankylosing Spondylitis Registry of Ireland. Patients with physical measurements for the calculation of anthropometric measures were included. BMI and waist-to-hip ratio (WHR) were used to compare classifications of obesity. Comparison analyses based on sex and central obesity were carried out. Multivariate analysis examined the effects of these factors on the following patient-reported outcomes: the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI), the Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire, and the Health Assessment Questionnaire (HAQ).

RESULTS

In total, 753 patients were included in the analysis. Of these patients, 29.6% (n = 223) were classified as obese based on their BMI, and 41.3% (n = 311) were classified as centrally obese according to the WHR. The prevalence of central obesity was significantly higher among women with axSpA compared to men (71.6% vs 29.9%, P < 0.01). Central obesity had a clear effect on patient outcomes, regardless of sex. Presence of central obesity was associated with significantly worse BASFI scores (P < 0.01), HAQ scores (P < 0.01), and ASQoL questionnaire scores (P = 0.01), with a nonsignificant trend toward worse BASDAI scores (P = 0.07).

CONCLUSION

There was a high prevalence of central obesity as assessed by the WHR in axSpA, most notably among women with axSpA. This modifiable comorbidity was significantly associated with worse quality of life, greater impairment of functional ability, and a trend toward worse disease activity. Regular use of the WHR to screen for central obesity as part of an axSpA assessment would provide an opportunity for prompt identification and intervention for at-risk patients.

Risk Factors for Coronary Heart Disease Among Lebanese Women: A Case–Control Study

Purpose

Women are increasingly concerned by coronary heart disease (CHD), with peculiarities of their own, particularly concerning risk factors. The aim of the study was to assess the risk factors for CHD in Lebanese women over forty.

Patients and Methods

A case–control study was carried out in 6 hospitals in Beirut and Mount-Lebanon, from December 2018 to December 2019 including 1500 patients (1200 controls and 300 cases). Women were stratified into pre- and post-menopausal groups. Personal and medical data were collected from hospital records and during an interview where validated questionnaires were used. Binary logistic regressions were performed to investigate potential predictors of CHD in the 2 groups.

Results

In post-menopausal women, dyslipidemia (adjusted odds ratio [aOR], 3.018; 95% confidence interval, 2.102–4.332), hypertension (aOR: 2.449, [1.386–4.327]), a family history of CHD (aOR: 2.724, [1.949–3.808]), cigarette smoking (aOR: 2.317, [1.574–3.410]) and common non-rheumatic joint pain (aOR: 1.457, [1.053–2.016]) were strongly associated with CHD. Conversely, living in Mount Lebanon seemed protective, compared to Beirut (aOR: 0.589, [0.406–0.854]), as well as having a moderate monthly income (aOR: 0.450, [0.220–0.923]), adhering to a Mediterranean diet (aOR: 0.965, [0.936–0.994]), and practicing physical activity [PA] (aOR: 0.396, [0.206–0.759] and 0.725, [0.529–0.992], respectively for high and moderate vs low PA). In pre-menopausal women, dyslipidemia (aOR: 6.938, [1.835–26.224]), hypertension (aOR: 6.195, [1.318–29.119]), family histories of dyslipidemia (aOR: 6.143, [1.560–24.191]) and CHD (aOR: 4.739, [1.336–16.805]) reached statistical significance.

Conclusion

The identification of factors associated with CHD in women, some of which are frequent and trivialized in post-menopause, underlines the need to put in place specific and dedicated CHD prevention strategies in women.

Clinical Overview of Arthritis with a Focus on Management Options and Preventive Lifestyle Measures for Its Control

ABSTRACT:

Arthritis is the spectrum of conditions that cause swelling and tenderness of one or more body joints with key symptoms of joint pain and stiffness. Its progression is closely tied to age. Although there are a number of arthritis types, such as, ankylosing, gout, joint infections, juvenile idiopathic, reactive and septic; the two most common types are osteoarthritis and rheumatoid arthritis. Osteoarthritis causes the articulating smooth cartilage that covers the ends of bones, where they form a joint, to breakdown. Rheumatoid arthritis is a disease in which the immune system attacks joints, beginning with the cartilaginous lining of the joints. The latter is considered a systemic disease, i.e. affecting many parts of the body, but the respiratory system is involved in 10 to 20 % of all mortality. Osteoarthritis is one of the leading causes of disability globally. Several preventive measures to control arthritis have been suggested, such as the use of analgesics, non-steroid anti-inflammatory drugs, moderate to vigorous physical activity and exercise, reducing sedentary hours, getting adequate sleep and maintaining a healthy body weight. Foods including, a Mediterranean diet rich in fruits and vegetables, fish oil, medicinal plants and microbiota are vital protective methods. The intake of vitamins such as A and C, minerals e.g., selenium and zinc; poly unsaturated and n-3 fatty acids is also a significant preventive measures.

Women's perception about hydrotherapy in postmenopause: a qualitative study

Abstract Introduction: The transition from reproductive to post-reproductive life is part of the female life cycle that impacts well-being, with menopause as a significant milestone. Regular physical activity should be encouraged to mitigate the symptoms of menopause and prevent age-related problems. Hydrotherapy is one such alternative, since immersion in heated water facilitates exercises that would be difficult to perform on land. Objective: Assess women’s perception about the effect of hydrotherapy on the signs and symptoms of postmenopause. Methods: A qualitative study in which participants underwent 48 hydrotherapy sessions and answered a semistructured interview. Results: The participants were eight women, aged 55.75 ± 8.55 years, menopausal for 8.5 ± 7.98 years, with vasomotor symptoms (100%), mood swings (87.5%), sleep disorders (87.5%), vaginal dryness (62.5%), low sex drive (62.5%) and chronic pain (100%). Conclusion: Women’s perception about the effects of hydrotherapy on the signs and symptoms of postmenopause include less pain and muscle tension, a decline in the signs and symptoms, better quality of life and sexual pleasure, and an improvement in biopsychosocial factors such as anxiety and stress through better social interaction.

Percepção de mulheres sobre a fisioterapia aquática na pós-menopausa: um estudo qualitativo

Resumo Introdução: A transição da vida reprodutiva para a pós-reprodutiva é considerada um dos ciclos da vida feminina que gera impactos no bem-estar da mulher, sendo a menopausa o marco significativo. A prática regular de atividade física deve ser encorajada para reduzir os sintomas da menopausa e prevenir alterações associadas ao envelhecimento. Assim, a fisioterapia aquática é uma opção de atividade física, pois a imersão em água aquecida possibilita a realização de exercícios que seriam difíceis de serem executados no solo. Objetivo: Evidenciar a percepção de mulheres sobre a fisioterapia aquática nos sinais e sintomas da pós-menopausa. Métodos: Trata-se de um estudo qualitativo, com participantes que realizaram 48 sessões de fisioterapia aquática e responderam a uma entrevista semiestruturada. Resultados: Participaram do estudo oito mulheres, 55,75 ± 8,55 anos, menopausadas há 8,5 ± 7,98 anos, com referência de alterações vasomotoras (100%), do humor (87,5%), do sono (87,5%), secura vaginal (62,5%), diminuição da libido (62,5%) e dor crônica (100%). Conclusão: A percepção das mulheres sobre os efeitos da fisioterapia aquática nos sinais e sintomas da menopausa aponta para uma diminuição do quadro álgico e da tensão muscular, diminuição dos sinais e sintomas da pós-menopausa, melhora da qualidade do sono, bem como do prazer sexual, e melhora nos fatores biopsicossociais como ansiedade e estresse, através da melhora da interação social.

ERα-Targeting PROTAC as a Chemical Knockdown Tool to Investigate the Estrogen Receptor Function in Rat Menopausal Arthritis

Proteolytic targeting chimeras (PROTACs) is a rapid and reversible chemical knockout method. Compared with traditional gene-editing tools, it can avoid potential genetic compensation, misunderstandings caused by spontaneous mutations, or gene knockouts that lead to embryonic death. To study the role of estrogen receptor alpha (ERα) in the occurrence and progression of menopausal arthritis, we report a chemical knockout strategy in which stable peptide-based (PROTACs) against ERα to inhibit their function. This chemical knockdown strategy can effectively and quickly inhibit ERα protein in vivo and in vitro. In the rat menopausal arthritis model, this study showed that inhibiting estrogen function by degrading ERα can significantly interfere with cartilage matrix metabolism and cause menopausal arthritis by up-regulating matrix metalloproteinase (MMP-13). The results of this study indicate that ERα is a crucial estrogen receptor for maintaining cartilage metabolism. Inhibition of ERα function by PROTACs can promote the progression of osteoarthritis.

The Causal Role of Magnesium Deficiency in the Neuroinflammation, Pain Hypersensitivity and Memory/Emotional Deficits in Ovariectomized and Aged Female Mice

Purpose

Postmenopausal women often suffer from chronic pain, memory decline and mood depression. The mechanisms underlying the neuronal disorders are not fully understood, and effective treatment is still lacking.

Methods

Oral administration of magnesium-L-threonate was tested to treat the neuronal disorders in ovariectomized and aged female mice. The pain hypersensitivity, memory function and depression-like behaviors were measured with a set of behavioral tests. Western blots, immunochemistry and in situ hybridization were used to assess molecular changes.

Results

Chronic oral administration of magnesium-L-threonate substantially prevented or reversed the chronic pain and memory/emotional deficits in both ovariectomized and aged female mice. We found that phospho-p65, an active form of nuclear factor-kappaB, tumor necrosis factor-alpha and interleukin-1 beta were significantly upregulated in the neurons of dorsal root ganglion, spinal dorsal horn and hippocampus in ovariectomized and aged mice. The microglia and astrocytes were activated in spinal dorsal horn and hippocampus. Calcitonin gene–related peptide, a marker for peptidergic C-fibers, was upregulated in dorsal horn, which is associated with potentiation of C-fiber-mediated synaptic transmission in the model mice. In parallel with neuroinflammation and synaptic potentiation, free Mg²⁺ levels in plasma, cerebrospinal fluid and in dorsal root ganglion neurons were significantly reduced. Oral magnesium-L-threonate normalized the neuroinflammation, synaptic potentiation and Mg²⁺ deficiency, but did not affect the estrogen decline in ovariectomized and aged mice. Furthermore, in cultured dorsal root ganglion neurons, estrogen at physiological concentration elevated intracellular Mg²⁺, and downregulated phospho-p65, tumor necrosis factor-alpha and interleukin-1 beta exclusively in the presence of extracellular Mg²⁺.

Conclusion

Estrogen decline in menopause may cause neuroinflammation by reducing intracellular Mg²⁺ in neurons, leading to chronic pain, memory/emotional deficits. Supplement Mg²⁺ by oral magnesium-L-threonate may be a novel approach for treating menopause-related neuronal disorders.

No Association Between Intrauterine Contraceptive Devices and Musculoskeletal Hip Joint Pain

Purpose

To investigate the association between intrauterine device (IUD) use and hip pain, orthopaedic visits for hip pain, and arthroscopic hip surgery.

Methods

This was a retrospective cohort study of patients aged 18-44 years old using either IUDs or subdermal implants for contraception in a large commercial claims database (MarketScan) from 2012 to 2015. All patients had at least 12 months of continuous enrollment both before and after contraceptive placement. Patients with a history of hip pain or surgery were excluded. The primary outcome was new hip pain. Secondary outcomes included visiting an orthopaedic or sports medicine provider for a hip complaint, intra-articular hip injection, and arthroscopic hip surgery. Outcomes were analyzed with Cox proportional-hazard models.

Results

We identified a total of 242,383 patients, including 216,541 (89.3%) with IUDs and 25,842 (10.7%) with subdermal contraceptive implants. In time-to-event analysis, IUDs (vs implants) were not associated with increased risk of new hip pain diagnoses (hazard ratio [HR] 0.95, 95% confidence interval [CI] 0.87-1.03, P = .21). In contrast, both age (P < .001) and region (P < .001) were associated with increased risk of new hip pain. Similar results were seen for the secondary outcomes, including risk of orthopaedic visits for hip complaints (HR 1.06, 95% CI 0.83-1.35, P = .63), intra-articular injections of the hip (HR 0.94, 95% CI 0.63-1.41, P = .77), and hip arthroscopy procedures (HR 1.13, 95% CI 0.53-2.40, P = .75).

Conclusions

In this study, we found no evidence that IUDs were associated with hip pain or surgery.

Level of Evidence

Level III, retrospective cohort.

Estrogen receptor Alpha in human knee articular cartilage of healthy and osteoarthritic females

Objective

Estrogen and osteoarthritis association has previously been proposed. This study evaluates the presence of estrogen receptors (ER)-α in articular cartilage, and its association.

Methods

A prospective cohort study of women undergoing anterior cruciate ligament reconstruction (controls) or total knee arthroplasty (cases) was performed. Cartilage samples were processed and ER-α expression was quantified.

Results

Twenty patients were included: 12 cases and 8 controls. ER-α expression was higher in the case subjects.

Conclusion

Increased ER-α expression is associated with age, and degeneration. This suggests estrogen deficiency is a risk for osteoarthritis and is inversely related to proliferative looking chondrocytes.

Can fibromyalgia be considered a characteristic symptom of climacterium?

Fibromyalgia syndrome (FMS) is a chronic pain syndrome, characterised by diffuse pain in musculoskeletal system and accompanied by stiffness, fatigue, tender points, sleep disturbances and cognitive and gastrointestinal symptoms. It affects middle-aged women (between 40 and 65) predominantly. Climacteric syndrome, which is characterised by vasomotor, somatic (headache, sleep disorders, myalgia and arthralgia) and psychical (mood changes) symptoms, results from the change in brain neurotransmitter concentrations due to gradual decline of ovarian hormone levels. Currently, studies focus on the similarities of FMS and climacteric syndrome in terms of age of occurrence, epidemiology, etiopathogenesis, symptomatology and treatment. Hormonal fluctuation during menopausal transition is likely the triggering factor for both syndromes. Therefore, hormone replacement therapy is a favourable approach in the treatment of FMS due to the antiallodynic, anti-inflammatory and neuroprotective effect of oestrogen. In this review, we emphasise the similarity of FMS and climacteric syndrome and suggested that FMS could be considered as a characteristic symptom of climacterium.

Associations Among Nitric Oxide and Enkephalinases With Fibromyalgia Symptoms

BACKGROUND

Fibromyalgia (FM) is a complex syndrome of uncertain etiology, characterized by the presence of widespread pain. Both nitric oxide and enkephalinases modulate pain perception.

OBJECTIVES

The aim of this study was to evaluate the relationships among serum nitric oxide levels, oxytocinase activity, and enkephalin-degrading aminopeptidase (EDA) activity with pain-related clinical manifestations in women with FM.

METHODS

We performed an observational case study in a population of 58 women diagnosed with FM. Serum nitric oxide levels were analyzed by an ozone chemiluminescence-based assay. Both serum oxytocinase and EDA activities were fluorometrically determined. Pain threshold and pain magnitude were evaluated using the PainMatcher. The pressure pain thresholds were measured using a digital pressure algometer. We used a visual analog scale, the Central Sensitization Inventory, the Revised Fibromyalgia Impact Questionnaire, and the Beck Anxiety Inventory to assess the global level of pain, the symptoms associated with the central sensitization syndrome, the severity of FM, and the anxiety level, respectively.

RESULTS

Multiple linear regression analysis adjusted by age, body mass index, and menopause status revealed significant associations between nitric oxide levels and dominant occiput pressure pain thresholds, nondominant occiput pressure pain thresholds, and FM effects. Significant associations of oxytocinase activity with the visual analog scale and dominant knee pressure pain thresholds were also found. Moreover, results showed a significant association between high EDA activity levels and dominant second-rib pressure pain thresholds.

DISCUSSION

Our data have shown significant relationships of serum nitric oxide levels and oxytocinase and EDA activities with some body pressure pain thresholds, the daily activity level, and the global intensity of pain in women with FM. These results suggest that pain, which is the main symptom of this syndrome, may be related to alterations in nitric oxide levels and in oxytocinase and EDA activities in patients with FM.

Prevalence of pain in women living with HIV aged 45-60: associated factors and impact on patient-reported outcomes

As the population of women with HIV ages, an increasing proportion are experiencing the menopause, with potential associated pain. Among 844 participants in the Positive Transitions Through the Menopause (PRIME) study (72.3% black African; median age 49 (interquartile-range 47-53) years; 20.9%, 44.0% and 35.1% pre-, peri- and post-menopausal), 376 (44.6%) and 73 (8.7%) reported moderate or extreme pain. Women had been diagnosed with HIV for 14 (9-18) years, 97.7% were receiving antiretroviral therapy and 88.4% had a suppressed viral load. In adjusted ordinal logistic regression, peri-menopausal status (adjusted odds ratio (1.80) [95% confidence interval 1.22-2.67]), current smoking (1.85 [1.11-3.09]), number of comorbid conditions (1.95 [1.64-2.33] /condition) and longer duration of HIV (1.12 [1.00-1.24]/5 years) were independently associated with increased reported pain, whereas being in full-time work (0.61 [0.45-0.83]) and having enough money for basic needs (0.47 [0.34-0.64]) were associated with decreased pain reporting. Increasing pain was independently related to insomnia symptoms (moderate: 2.76 [1.96-3.90]; extreme: 8.09 [4.03-16.24]) and severe depressive symptoms (PHQ4 ≥ 6; moderate: 3.96 [2.50-6.28]; extreme: 9.13 [4.45-18.72]). Whilst our analyses cannot determine the direction of any associations, our findings point to the importance of eliciting a history of pain and addressing symptoms in order to improve wellbeing.

Does bevacizumab increase joint pain in patients with cancer? Results of the prospective observational BEVARTHRALGIA study

PURPOSE

The occurrence of arthralgia and myalgia during treatment with bevacizumab (Bev) has been described but not spontaneously reported. We aimed to evaluate the frequency of arthralgia in patients treated with Bev and identify the risk factors.

METHODS

In this observational prospective study, a self-administered questionnaire was distributed to patients at the initiation of Bev and at 3 and 6 months of treatment. Bev (5-15 mg/kg) was administered every 2 or 3 weeks, with or without chemotherapy.

RESULTS

A total of 71 patients (42 with colorectal cancer, 22 with ovarian cancer, and 7 with lung cancer) were enrolled from January to November 2018. All patients completed the questionnaire at initiation, while only 56 (78.9%) and 36 (50.7%) patients completed the questionnaire at 3 and 6 months, respectively. The frequency of joint pain was 29.6% before Bev treatment and increased to 41.8% and 50% at 3 and 6 months, respectively, without reaching significance. The evolution of pain was significant according to the Common Terminology Criteria for Adverse Events grades (P = 0.032). No significant increase in the impact of pain on instrumental or elementary activities was observed over time. The frequency of arthralgia significantly increased at 3 months in patients with ovarian cancer versus those with colorectal cancer (odds ratio: 19.50; 95% confidence interval 4.53-83.98; P < 0.001).

CONCLUSIONS

Bev‑including regimens tend to be associated with a significant increase in the frequency of arthralgia in women treated for ovarian cancer. Physicians should be aware of this side effect.

CLINICAL TRIAL NUMBER

NCT03455907, date of registration: March 7, 2018.

Joint involvement influences quality of life in systemic lupus erythematosus patients

INTRODUCTION

Joint involvement represents the major determinant in quality of life (QoL)in Systemic Lupus Erhytematosus (SLE) patients. However, QoLhas been generally evaluated by non-specific questionnaires. We evaluated the relationship between SLE musculoskeletal manifestations and QoL, assessed by LupusQoL.

METHODS

Patients with joint involvement (group A) were compared with those without this feature (group B). Disease activity was assessed by SLEDAI-2k in the whole population, while DAS28 and swollen to tender ratio were applied to assess joint activity. LupusQoL was administered to all the patients.

RESULTS

Group A included 110 patients [M/F 8/102; median age 49 years (IQR 13), median disease duration 156 months (IQR 216)], group B 58 [M/F 11/47; median age 40 years (IQR 15), median disease duration 84 months (IQR 108)].We found significanlty lower values in all the LupusQoL domains except for one (burden to others) in group A in comparison with group B. A significant correlation between DAS28 values and all the LupusQoL domains in group A was found; only three domains correlated with SLEDAI-2k.

CONCLUSIONS

SLE-related joint involvement significantly influences disease-specific QoL. DAS28 better correlated with LupusQoL domains in comparison with SLEDAI-2k, confirming the need for specific musculoskeletal activity indices.

Sex-Specific Differences in Extracellular Vesicle Protein Cargo in Synovial Fluid of Patients with Osteoarthritis

Women are at a significantly higher risk of developing osteoarthritis (OA) compared to males. The pathogenesis of osteoarthritis (OA) in women is poorly understood. Extracellular vesicles (EVs) have been shown to play an essential role in numerous signaling processes during the pathogenesis of age-related diseases via paracrine signaling. Molecular profiling of the synovial fluid-derived EVs cargo in women may help in the discovery of novel biomarkers and therapeutics for the treatment of OA in women. Previously, we reported that synovial fluid-derived EV miRNA cargo differs in a sex-specific manner. This study aims to characterize synovial fluid-derived EV protein cargo in OA patients. Our data showed sex-specific EVs protein content in OA. We found haptoglobin, orosomucoid, and ceruloplasmin significantly up-regulated, whereas apolipoprotein down-regulated in female OA EVs. In males, we discovered β-2-glycoprotein, and complement component 5 proteins significantly up-regulated and Spt-Ada-Gcn5 acetyltransferase (SAGA)-associated factor 29 down-regulated in male OA EVs. Database for Annotation, Visualization, and Integrated Discovery (DAVID) and QuickGO analysis revealed OA-specific protein involvement in several biological, molecular, and cellular pathways, specifically in inflammatory processes. In conclusion, synovial fluid EV protein content is altered in a sex-specific manner with OA, explaining the increased prevalence and severity of OA in women.

Menopausal factors and risk of seropositive rheumatoid arthritis in postmenopausal women: a nationwide cohort study of 1.36 million women

In previous literature regarding development of rheumatoid arthritis (RA), female reproductive factors have been described as protective factors, risk factors, or irrelevant, leading to inconsistent results. The aim of this study was to investigate the effect of female reproductive factors on the incidence of seropositive RA. A large population-based retrospective cohort of the National Health Insurance Service data in South Korea was used. Postmenopausal women who participated in both cardiovascular and breast cancer screening in 2009 were included and followed until date of seropositive RA diagnosis, death, or December 31, 2018. Multivariable-adjusted Cox proportional hazards model was used to assess the association between reproductive factors and incident seropositive RA. Of 1,357,736 postmenopausal women, 6056 women were diagnosed with seropositive RA, and the incidence rate was 54.16 cases/100,000 person-years. Reproductive factors other than hormone replacement therapy (HRT) were not significantly associated with seropositive RA incidence. Postmenopausal women who used HRT ≥ 5 years were associated with a higher aHR of incident seropositive RA than never-users (aHR 1.25; 95% CI 1.09–1.44). Alcohol consumption less than 30 g per day (aHR 0.80; 95% CI 0.74–0.87), regular physical activity (aHR 0.90; 95% CI 0.84–0.97), diabetes mellitus (aHR 0.85; 95% CI 0.78–0.93), and cancer (aHR 0.77; 95% CI 0.64–0.92) were associated with lower risk of seropositive RA. Most female reproductive factors did not significantly affect the development of seropositive RA in postmenopausal women. Only HRT is associated with a small but significant increase in risk of seropositive RA.

Musculoskeletal Pain during the Menopausal Transition: A Systematic Review and Meta-Analysis

Musculoskeletal pain (MSP) is one of the most severe complaints in women undergoing menopause. The prevalence of MSP varied when taking the menopausal state and age factor into consideration. This study investigated the prevalence of MSP in perimenopausal women and its association with menopausal state. The MEDLINE, Embase, Web of Science, and PubMed databases were searched from inception to July 2020, and 16 studies were retrieved for the current meta-analysis. The primary outcome measure was the MSP Odds Ratio (OR). The estimated overall prevalence of MSP among perimenopausal women was 71% (4144 out of 5836, 95% confidence interval (CI): 64%-78%). Perimenopausal women demonstrated a higher risk for MSP than premenopausal ones (OR: 1.63, 95% CI: 1.35-1.96, P = 0.008, I² = 59.7%), but similar to that in postmenopausal ones (OR: 1.07, 95% CI: 0.95–1.20, P = 0.316, I² = 13.4%). The postmenopausal women were at a higher risk of moderate/severe MSP than the premenopausal ones (OR: 1.45, 95% CI: 1.21-1.75, P = 0.302, I² = 16.5%) or the perimenopausal ones (OR: 1.40, 95% CI: 1.09–1.79, P = 0.106, I² = 55.4%). In conclusion, the perimenopause is a state during which women are particularly predisposed to develop MSP. As to moderate to severe degrees of MSP, the odds increase linearly with age, from premenopause to peri- and then to postmenopause.

A systematic review of internet-based interventions for women with chronic pain

Introduction

To evaluate the effects of internet-based interventions on physical and psychosocial outcomes in women with chronic pain through a systematic review.

Method

A search of the following electronic databases: PubMed/MEDLINE, ScienceDirect, and Web of Science. Two different authors separately tabulated the indices selected in identical predetermined forms. The methodological quality of all randomised trials was assessed using the Cochrane Collaboration’s tool for assessing the risk of bias.

Results

Seven articles were finally included. The main features of interventions included online cognitive-behavioural and/or psychoeducation therapy to improve health with an interactive component. The methodological quality showed a high risk of bias, mainly from a lack of blinding.

Conclusion

There are indicators that suggest that internet-based interventions may be useful for women with chronic pain. However, the validity of such a conclusion is limited as most trials included had a high risk of bias. More rigorous research is required before stating that such interventions can overcome the current limitations of traditional face-to-face care.

Chinese women's health and wellbeing in middle life: Unpacking the influence of menopause, lifestyle activities and social participation

OBJECTIVES

To examine Chinese middle-aged women's health and wellbeing and the associated biosocial correlates.

STUDY DESIGN

This study used a cross-sectional design, including selected retrospectively collected information on the final menstrual period, drawn from the 2013 wave of the China Health and Retirement Longitudinal Study (CHARLS). Women aged 45 to 59 were selected.

MAIN OUTCOME MEASURES

Factor analysis of 16 menopausal symptom ratings yielded four different and independent measures of pre-/peri-menopausal and early postmenopausal women's health. These were: negative mood (feel frustrated, sad, lonely, worried, bored, angry, tired and stressed), positive emotions (feel enthusiastic, content and happy), musculoskeletal pain (shoulder/neck pain, knee and other joint pain, and back pain), and sleep and memory problems (trouble sleeping and poor memory).

RESULTS

Menopausal status was positively associated with sleep and memory problems, whilst the number of years since the final menstrual period was positively associated with musculoskeletal pain. In contrast, lifestyle activities and social participation were linked to positive emotions. The association between selected biosocial factors and negative mood was not significant after controlling for other demographic and social background factors.

CONCLUSIONS

Musculoskeletal health as well as sleep and memory problems are positively associated with menopausal biological factors amongst Chinese mid-life women. Maintaining active social engagement contributes to positive wellbeing among middle-aged women.