Menopause Associated Arthralgia
Original Editor - Habibu salisu Badamasi
Top Contributors - Sehriban Ozmen and Habibu Salisu Badamasi
Introduction[edit | edit source]
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.[1]
Prevalence[edit | edit source]
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. [1]
Aetiology[edit | edit source]
Causes of arthralgia in menopausal women:
- Primary/idiopathic (peri-menopausal)
- Secondary causes:
- Endocrine: Hypothyroidism, Hyperparathyroidism (primary or secondary), Vitamin D deficiency, Anaemia
- Drug related: Statins and other lipid-lowering drugs, Aromatase inhibitors, Selective estrogen receptor modulators, Bisphosphonates (particularly intravenous), Thiazide diuretics
- Metabolic: Liver disease, Renal disease
- Rheumatic: Connective tissue disease (Lupus*, Scleroderma, Sjogrens*) Sarcoidosis*, Vasculitis, Hyperuricaemia, Hypermobility
- Infection: Parvovirus*, Hepatitis B*/C*/HIV*, Ross River virus*, Brucellosis*, Whipple’s disease*, Lyme disease*
- Malignancy: Disseminated bony malignancy, Paraneoplastic syndrome, [2] Multiple Myeloma [1]
*May be associated with arthralgia or a frank arthritis.
Clinical Presentation[edit | edit source]
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[edit | edit source]
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. [2]
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. [2]
Secondary cause of arthralgia history should be considered, such as thyroid disease or vitamin D deficiency. [2]
Outcome Measures[edit | edit source]
Pain visual analogue scale or numerical rating scale from 0 to 10 should be used to measure joint pain. [2]
Differential Diagnosis[edit | edit source]
Around menopause, women have a higher prevalence of osteoarthritis (OA), particularly in the hands, and rheumatoid arthritis (RA). [2] The decreasing levels of estrogen during menopause can result in joint synovium and cartilage damage, which is often misdiagnosed as RA, degenerative OA, or fibromyalgia. [3] One study [4] indicated that almost half of the people diagnosed with RA were misdiagnosed, while they had either menopausal arthralgia or menopausal OA. [3] Given them, differential diagnosis of the arthralgia of menopause, especially from RA, OA or other rheumatologic conditions that can mimic the arthralgia of menopause, should be provided.
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. [2]
- Does the patient have a joint-based site? (Single, or multiple? Symmetrical? Episodic vs. progressive? With activity? )
- Is there early morning stiffness > 30 min?
- Can I see joint swelling? (Are the joints red? Are the joints tender? Is there MCP joint swelling?)
Individuals presenting with suspected inflammatory arthritis, such as RA, should be promptly referred to an early arthritis clinic for further assessment. [2]
Management[edit | edit source]
- Hormone Replacement Therapy (HRT): Most studies indicate that HRT can relieve arthralgia in postmenopausal women. [1]
- Lifestyle changes: There is evidence that moderate physical activity can improve arthralgia and other menopause-related symptoms. [5] A clinical trial found that a complex intervention including dietary and exercise supervision reduced arthralgia. [6]
Resources[edit | edit source]
A patient information guide by National Health Service (NHS)
References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 Magliano M. Menopausal arthralgia: Fact or fiction. Maturitas. 2010 Sep 1;67(1):29-33.
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 Watt FE. Musculoskeletal pain and menopause. Post reproductive health. 2018 Mar;24(1):34-43.
- ↑ 3.0 3.1 Blumer J. Arthralgia of menopause-A retrospective review. Post Reproductive Health. 2023 Jun;29(2):95-7.
- ↑ Gomez D, Saavedra-Martinez G, Villarreal L, Santos-Moreno P, Bello-Gualtero J, Giraldo V, Martinez P, Sanchez A, Sanchez M, Uribe E, Boon M. SAT0108 misdiagnosis of rheumatoid arthritis–the photography.
- ↑ Aparicio VA, Borges-Cosic M, Ruiz-Cabello P, Coll-Risco I, Acosta-Manzano P, Špacírová Z, Soriano-Maldonado A. Association of objectively measured physical activity and physical fitness with menopause symptoms. The Flamenco Project. Climacteric. 2017 Sep 3;20(5):456-61.
- ↑ Xi S, Mao L, Chen X, Bai W. Effect of health education combining diet and exercise supervision in Chinese women with perimenopausal symptoms: a randomized controlled trial. Climacteric. 2017 Mar 4;20(2):151-6.
