Sustained clinical benefits of menopausal hormone therapy for symptomatic hand osteoarthritis: A 12-month follow-up study in perimenopausal women

Background Symptomatic hand osteoarthritis (HOA) is prevalent among perimenopausal women and may be associated with estrogen deficiency. Although menopausal hormone therapy (MHT) has shown short-term benefits, its long-term efficacy remains unclear. Objective To evaluate 12-month outcomes in perimenopausal women with symptomatic HOA. Design Retrospective single-arm observational study. Methods This retrospective observational study at the Menopause and Hand Clinic, Kagoshima University Hospital, included 45 women with symptomatic HOA who initiated MHT between April 2019 and December 2022 and completed 12 months of follow-up. Diagnosis was based on the EULAR recommendations. MHT was prescribed according to uterine status. No additional orthopedic treatments were administered. Disabilities of the Arm, Shoulder and Hand (DASH), visual analog scale (VAS), and grip strength were assessed at baseline and at 3, 6, and 12 months. Minimal clinically important differences (MCIDs) were predefined. Results Of 54 patients who initiated MHT, 45 (83.3%) completed 12-month follow-up. Repeated-measures analysis of variance showed a significant main effect of time on DASH and VAS scores (p < 0.001). DASH score improved by −8.8 points (95% CI, −13.2 to −5.0), which did not reach the MCID, whereas VAS score decreased by −28.4 mm (95% CI, −35.0 to −21.2), exceeding the MCID. Grip strength significantly increased in both hands (both p < 0.001). Improvements were greatest at 3 months and were maintained at 12 months. No serious adverse events occurred, and no patient discontinued MHT. Conclusions In this retrospective single-arm study, improvements in hand pain, upper-extremity function, and grip strength following MHT initiation were maintained over 12 months in perimenopausal women with symptomatic HOA. Clinically meaningful improvement was observed for hand pain, but not upper-extremity function. Further prospective studies are warranted to establish causality and determine the long-term effectiveness of MHT.