INFLAMMATION, MENOPAUSE, AND WOMEN’S HEALTH: A RHEUMATOLOGICAL PERSPECTIVE

Inflammatory rheumatic disorders come with their plethora of complications including accelerated ovarian aging and the associated adversities which could be a consequence of disease itself or treatment with immunosuppressants. While aiming for treat-to-target in these patients, its effect on the ovaries takes a backseat. This review focusses on this underexplored avenue of effect of inflammation, inflamm-aging and the associated complications that come with early menopause, in the context of autoimmune rheumatic diseases (AIRDs). Some autoimmune diseases like lupus have a major role of estrogen in their causation and tend to be less severe when the onset is after menopause, while in other inflammatory arthritis like rheumatoid arthritis (RA), estrogen may have some anti-inflammatory potential. Inflamm-aging that is associated with the AIRDs also leads to early menopause and premature ovarian insufficiency in some patients, which adds-on to the morbidity and sometimes, mortality. With early ovarian aging and precipitous decline in circulating estrogen, there is accelerated reduction in the bone mass and early set-in of osteoporosis. Long-term steroids, on-going inflammation and RA itself are major risk factors. The high risk of detrimental fragility fractures in these patients with a consequential reduction in the quality of life with higher loss of disability adjusted life years (DALY) and poorer functional outcomes, contributes to long-term morbidity. While remission induction and maintenance are a major part of treatment, physicians should exercise a keen eye towards recognizing early menopause and its adversities and inculcate measures for osteo-protection and prevent adding on to the morbidity. Future prospects would include attempts at delaying ovarian aging by targeting mTOR/S6 kinase pathways and preservation of ovarian tissue.