MENOPAUSE status significantly shapes the clinical presentation of systemic sclerosis (SSc), according to new findings from a multicenter analysis of over 1,500 women enrolled in the SPRING-SIR registry. The study highlights key phenotypic differences in disease expression between post-menopausal and pre-menopausal women, as well as those who experience early menopause.
Researchers examined data from 1,538 women with SSc, all meeting the 2013 ACR/EULAR classification criteria. At baseline, 75% of patients were post-menopausal, with just over half having developed the disease before menopause. Notably, 14.4% reported early menopause, defined as occurring before age 45.
Distinct clinical patterns emerged across menopausal groups. Post-menopausal patients more often presented with limited cutaneous SSc, anti-centromere antibody positivity, interstitial lung disease, and gastrointestinal involvement. In contrast, patients with SSc onset before menopause showed higher rates of diffuse skin involvement and peripheral vasculopathy.
Particularly concerning were the outcomes among those with early menopause. This subgroup was independently associated with increased risk for digital ulcers and had reduced pulmonary diffusing capacity, suggesting more severe vascular and pulmonary involvement. These associations persisted even after adjusting for potential confounders.
The authors conclude that menopausal status, especially early menopause, should be considered a relevant factor in the assessment and management of systemic sclerosis. Hormonal shifts may influence disease expression, pointing to the importance of tailored screening and therapeutic strategies based on reproductive history.
These findings underscore the need for clinicians to routinely assess menopausal history in female patients with SSc. Incorporating this information could facilitate earlier recognition of high-risk phenotypes and optimize disease management.
Reference:
Orlandi M et al. Menopause in systemic sclerosis: the impact on clinical presentation in a multicenter cross-sectional analysis from the National Registry of the Italian Society for Rheumatology (SPRING-SIR). Ther Adv Musculoskelet Dis. 2025:17:1759720X251354898.
