Pos0821 Menopause and Systemic Sclerosis: The Link Between Menopausal Age, Disease Onset and Clinical Manifestations in an Analysis of the Spring-Sir Registry

Background: In a woman's lifetime, menopause represents a time of significant hormonal change, which might interact with underlying autoimmune diseases, such as Systemic sclerosis (SSc). On this basis, it could be hypothesised that menopause may affect the onset and clinical manifestations of SSc. Objectives: We aimed to (1) compare the pre- versus post-menopausal onset of SSc and (2) early versus regular menopause in term of clinical, laboratory and functional presentation of SSc. Methods: Female SSc patients from the Italian SPRING registry, fulfilling the ACR/EULAR 2013 classification criteria, with available information on disease onset (as of first non-Raynaud's phenomenon sign/symptom), menopausal status and menopausal age were eligible for this analysis. SSc onset was categorized as pre-menopausal if SSc onset happened >1 year before menopausal age or as post-menopausal onset if SSc onset occurred >1 year after menopause, otherwise as peri-menopausal. Early menopause was defined as menopausal age <45 years. Comparison between pre- vs post-menopausal SSc onset, as well as between regular vs early menopausal age were performed with Chi-square and T-test. Logistic and linear regression models were built to test the association between pre-menopausal onset and early menopause with SSc-related characteristics, after adjustment for covariates selected according to literature evidence and personal experience. Results: Among 2140 patients included in the SPRING-SIR registry, 1254 female patients fulfilled the classification criteria: 632/1254 (50.4%) had a pre-menopausal and 568 (45.3%) a post-menopausal SSc onset; 902/1254 (72%) patients were in menopause at the time of enrollment in the registry, 130 (14.4%) reporting an early menopausal age (Table 1). Given the paucity of the peri-menopausal group, this was excluded from the analysis. In comparison to post-menopausal onset patients, pre-menopausal onset SSc cases were more frequently ATA+, with diffuse cutaneous involvement and peripheral vasculopathy (both digital pitting scars, digital ulcers and late scleroderma pattern on nailfold capillaroscopy). Additionally, both disease duration and modified Rodnan's skin score were higher in the pre-menopausal onset group. Despite these differences, after adjustment for co-variates, pre-menopausal SSc onset was not a statistically significant, independent predictor of any of the abovementioned parameters. In the 902 post-menopausal cases, we observed that patients with early menopause presented more frequently with digital ulcers and interstitial lung disease, in line also with significantly lower FVC% and Dlco% values and more frequent reporting of dyspnea. When modelled together with co-variates (Figure 1 A-D), early menopause was a statistically significant risk factor for presence of digital ulcers and lower Dlco% values. Additionally, early menopause showed a trend towards statistical significance as a risk factor for presence of ILD and lower FVC% values. Table 1. Conclusion: Our data suggest that an early menopause may impact on SSc course, being associated with a more severe disease, impacting on both vascular and fibrotic manifestations of the disease. Menopausal age should be therefore thoroughly addressed in SSc female patients, aiming at a better management of disease. REFERENCES: NIL. Acknowledgements: national Systemic sclerosis PRogression INvestiGation (SPRING) registry and Italian Society of Rheumatology (SIR) Disclosure of Interests: Martina Orlandi: None declared, Dilia Giuggioli: None declared, Rossella De Angelis: None declared, Valeria Riccieri: None declared, Francesca Ingegnoli: None declared, Fabio Cacciapaglia: None declared, Corrado Campochiaro: None declared, Veronica Codullo: None declared, Serena Guiducci: None declared, Silvia Bellando-Randone: None declared, Clodoveo Ferri: None declared, Marco Matucci-Cerinic Actelion, Janssen, Inventiva, Bayer, Biogen, Boehringer, CSL Behring, Corbus, Galapagos, Mitsubishi, Samsung, Regeneron, Acceleron, MSD, Chemomab, Lilly, Pfizer, Roche., Cosimo Bruni Actelion, Janssen, Inventiva, Bayer, Biogen, Boehringer, CSL Behring, Corbus, Galapagos, Mitsubishi, Samsung, Regeneron, Acceleron, MSD, Chemomab, Lilly, Pfizer, Roche.