News in brief: Why menopause matters in rheumatology assessments; Gut microbiota dysfunction may raise urate levels; Tobacco sales ban is next step for smoke-free Australia

22 Nov 2021

Why menopause matters in rheumatology assessments

Rheumatologists should consider menopause as part of a holistic assessment of female patients and be “mindful” of its potential to impact disease progression or be the cause of a misdiagnosis.

In a paper published in Rheumatology, Consultant Rheumatologist Dr Zoe McLaren, from Liverpool University Hospitals NHS Foundation Trust, and GP Olivia Hum, from Foundry Healthcare Lewes, highlighted that women with menopause are at risk of being misdiagnosed as many of those presenting in primary care with morning stiffness and “a host of musculoskeletal symptoms” are referred to rheumatology clinics.

“Misdiagnosis has consequences for a patient in terms of inappropriate labels and exposure to unnecessary and potentially toxic medications that are not needed,” they said, added to which it may also “deny the woman timely, symptomatic relief, where treatment with hormone replacement can be transformative.”

However, they also stressed that recognition of perimenopause and menopause is equally important in patients with established rheumatoid disease, as they “can result in apparent altered disease activity, and well-recognised increased cardiovascular and bone health risks”.

“The role of the rheumatologist here may be in balancing the risk of disease flare against co-morbidity, and in supporting informed shared decision making with the GP or menopause specialist around the use of HRT in individual patients,” they suggested.

“It is important that we break down silos of expertise, arm ourselves with the knowledge to recognise the potential symptoms of the menopause and perimenopause, and consider how that might be contributing to the picture before us.”


Metabolic dysfunction of gut microbiota could raise serum urate levels

New research has raised the possibility that an imbalance in gut microbiota could modulate serum urate levels in humans.

The study, led by researchers in China and published in Arthritis & Rheumatology, was first to investigate the association between the gut microbial community and hyperuricemia, and thus its potential relationship with the development of gout and other metabolic diseases.

The team looked at data from 1, 392 participants in a rural, community-based observational study, the

Xiangya Osteoarthritis Study (the discovery cohort), analysed gut microbiota using rRNA sequencing from stool samples, and examined the relation of microbiota dysbiosis and predicted functional pathways to hyperuricemia and serum urate levels.

They then verified predicted associations in 240 participants with hyperuricemia and 240 age-sex matched controls without hyperuricemia, selected from the Step Study (the validation cohort), a longitudinal study involving people living in an urban area.

The results showed that people with hyperuricemia have “decreased richness and diversity, altered overall composition of gut microbiota, low relative abundance of genus Coprococcus, as well as altered KEGG pathways related to the amino acid and nucleotide metabolisms compared with those with normouricemia,” the authors noted.

They also said similar associations were seen between microbiota dysbiosis and serum urate levels, and that the findings were replicated in an independent urban validation cohort.

“Taken together, these findings suggest that metabolic dysfunction of gut microbiota may affect SU levels through its effect on levels of the host metabolites,” the researchers concluded.


Tobacco sales ban is next step for smoke-free Australia

The government must set an ‘end date’ to phase out retail sales of tobacco altogether if it is to meet its goal of reducing smoking to below 5% by 2030, public health advocates say.

Writing in the MJA, Associate Professor Coral Gartner of the University of Queensland says the continuing availability of tobacco from retail outlets normalises smoking as a behaviour for young people and the only realistic action plan to reduce consumption is to reduce the number of retail outlets.

The authors say industry self‐regulation and other voluntary approaches will not reduce tobacco retailing, and there is a need to adopt approaches such as a restricting sales to a limited number of licensed dealers or putting tobacco on prescription.

Setting an end date for tobacco sales will also focus efforts on smoking cessation and force the government to plan for an end to tobacco tax revenue, they write.

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