Menopause Associated Arthralgia

Original Editor - Habibu salisu Badamasi

Top Contributors - Sehriban Ozmen and Habibu Salisu Badamasi

This article is currently under review and may not be up to date. Please come back soon to see the finished work! (09/09/2023)

Introduction

Musculoskeletal pain is reported by more than half of women at the time of menopause. Joint pain presentation is common in women between the ages of 45 and 55 years of age. However, there is no strong evidence of the association of menopause and estrogen deficiency as the cause of joint pain in women. Arthralgia, unlike arthritis or rheumatology disorders, is a subjective presentation describing pain in the joints. While arthritis is a pathological condition that damages the joints with associated joint pain symptoms and signs, and rheumatology disorder is an inflammatory condition. But not all patients experiencing Arthralgia during the time of menopause often do not have or develop associated arthritis. The pain may be associated with hormonal changes or secondary reversible conditions, which are essential to be ruled out.

Prevalence

Joint pain is undoubtedly widespread during menopause, but the link between reported musculoskeletal complaints and menopausal transition is more difficult to establish. A study investigating menopausal symptoms found joint pain, joint stiffness or backache in 51–59% of women . Joint pains and muscular discomfort are most commonly reported symptoms by Nigerian women age 40–60 and Spanish women age 45–55 and 21% of these women joint pain constitutes the most bothersome menopausal complaint.

Aetiology

Causes of arthralgia in menopausal women:

• Primary/idiopathic (peri-menopausal)

• Secondary causes:

1. Endocrine: Hypothyroidism, Hyperparathyroidism (primary or secondary), Vitamin D deficiency, Anaemia
2. Drug related: Statins and other lipid-lowering drugs, Aromatase inhibitors, Selective estrogen receptor modulators, Bisphosphonates (particularly intravenous), Thiazide diuretics
3. Metabolic: Liver disease, Renal disease
4. Rheumatic: Connective tissue disease (Lupus*, Scleroderma, Sjogrens*) Sarcoidosis*, Vasculitis, Hyperuricaemia, Hypermobility
5. Infection: Parvovirus*, Hepatitis B*/C*/HIV*, Ross River virus*, Brucellosis*, Whipple’s disease*, Lyme disease*
6. Malignancy: Disseminated bony malignancy, Paraneoplastic syndrome, Multiple Myeloma

*May be associated with arthralgia or a frank arthritis.

Clinical Presentation

Usually, the musculoskeletal symptoms include

• Muscle and joint aches and pains
• Joint stiffness
• Joint swelling
• Reduced muscle strength
• Low stamina
• Pins and needles
• Fatigue

Diagnostic Procedures

A detailed history should be carried out on a patient with joint pain. Usually, musculoskeletal pain does not always originate from the joint and does not refer to arthralgia. Because there are different causes of pain. Pain away from the joint may originate from bone, muscles, bursae, or entheses.

A history of joint injury, occupation related, past or family history of psoriasis, uveitis or inflammatory bowel disease, and a history of menopause should be investigated.

Secondary cause of arthralgia history should be considered, such as thyroid disease or vitamin D deficiency.

Outcome Measures

Pain visual analogue scale or numerical rating scale from 0 to 10 should be used to measure joint pain.

Differential Diagnosis

For non-specialists, it is important to examine and assess joints by talking to the patient, observing and palpating the joints, and documenting the 3 ‘S’s listed below. This can help to differentiate between arthralgia, pre-arthritis, or different types of arthritis.

1. Does the patient have joint-based site? (Single, or multiple? Symmetrical? Episodic vs. progressive? With activity? )
2. Is there early morning stiffness > 30 min?
3. Can I see joint swelling? (Are the joints red? Are the joints tender? Is there MCP joint swelling?)

Around menopause, women have a higher prevalence of osteoarthritis, particularly in the hands, and rheumatoid arthritis (RA). Individuals presenting with suspected inflammatory arthritis, such as RA, should be promptly referred to an early arthritis clinic for further assessment.

Management

1. Hormone replacement therapy (HRT)- The majority of studies demonstrate that hormone replacement alleviates arthralgia in postmenopausal women.