Women with psoriatic arthritis (PsA) appear to experience increased disease activity, measured either objectively or subjectively, during the perimenopause stage, as shown in a study.
In a cohort of female PsA patients followed from 1978 to 2024, “a rise in Disease Activity in PsA (DAPSA) scores was found during perimenopause years, followed by a slight drop post-menopause,” reported first study author Dr Lihi Eder from the University of Toronto in Toronto, Canada.
Linear mixed models showed a significant association between being in perimenopause and higher DAPSA scores relative to the premenopause (β, 1.92, 95 percent confidence interval [CI], 0.87–2.97; p<0.001) and post-menopause stages (β, 1.56, 95 percent CI, 0.66–2.47; p=0.001). [EULAR 2026, abstract OP0246]
Similar findings were observed in an analysis that used subjective measures of disease activity.
Perimenopause was associated with markedly greater tender joint (TJC) and swollen joint (SJC) counts compared with both premenopause (TJC: β, 1.04, 95 percent CI, 0.42–1.67; SJC: β, 0.60, 95 percent CI, 0.29–0.90; p=0.001 and p<0.001, respectively) and post-menopause (TJC: β, 0.77, 95 percent CI, 0.22–1.32; SJC: β, 0.54, 95 percent CI, 0.27–0.81; p=0.006 and p<0.001, respectively).
Functional disability as assessed using the Health Assessment Questionnaire Disability Index was also substantially worse during the perimenopause vs post-menopause stage (β, –0.05, 95 percent CI, –0.10 to –0.01; p=0.02), as was disease severity measured using the Psoriasis Area Severity Index (β, 0.57, 95 percent CI, 0.18–0.95; p=0.0004).
In mediation analyses, fatigue (measured using Functional Assessment of Chronic Illness Therapy-Fatigue scores) emerged as a partial mediator of the increase in DAPSA scores during perimenopause.
“It’s possible that some of the increase in DAPSA score during perimenopause vs pre- or post-menopause was mediated in part by fatigue or sleep difficulties,” Eder noted.
On the other hand, BMI showed no significant mediating effect, she added.
In light of the findings, Eder emphasized the need for rheumatologists to be aware of possible PsA flares during the perimenopausal window. “It’s important to ask about these symptoms and consider hormone replacement therapy, especially if patients have additional perimenopausal symptoms.
“We definitely need more research to understand the effect of sex hormones during different life stages on females with PsA,” she said.
The study included 477 female PsA patients who provided data for 8,381 visits over a mean follow-up of 12.1 years. Mean age at first visit was 44.9 years, and mean age at menopause was 48.7 years. Hormone replacement therapy had only been used during 1.5 percent of visits.