Menopausal hormone therapy may increase risk for late-onset rheumatoid arthritis
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Key takeaways:
- Oral contraceptives may reduce the risk for rheumatoid arthritis, while menopausal hormone therapy may increase risk.
- The findings could lead to the development of new drugs and better clinical guidelines.
Oral contraceptives may protect against rheumatoid arthritis, while menopausal hormone therapy could increase risk for late-onset RA, according to data published in Rheumatology.
“The female-to-male ratio of RA is significantly higher in patients under 50years of age, and the incidence peaks during menopausal transition which coincides with decreased ovarian function,” Fatemeh Hadizadeh, MD, PhD, of Uppsala University, in Sweden, and colleagues wrote.
“Furthermore, variations in disease activity have been observed during hormonal transitional periods like pregnancy, post-partum and breastfeeding,” they added. “This has prompted investigations into the influences of endogenous sex hormones but also the effects of exogenous hormone exposures, particularly oral contraceptives (OC) and menopausal hormone therapy (MHT) on RA development.”
To explore the impacts of oral contraceptives on the risk for RA, as well as how MHT affects late-onset RA risk, Hadizadeh and colleagues conducted a prospective cohort study analyzing U.K. Biobank data. The researchers included data from 239,785 white British women and used time-dependent Cox regression modeling to calculate risk. They then replicated the analysis across 257,194 women from “all different ethnic groups,” the researchers wrote.
A total of 184,669 of the included white British women reported a history of oral contraceptive use. Meanwhile, for the MHT analysis — which included 102,466 women aged older than 60 years — 51,120 were included as ever-users of MHT.
According to the researchers, patients with a history of oral contraceptive use demonstrated a lower risk for RA (HR = 0.89; 95% CI, 0.82-0.95) than those who never used it. In addition, the risk was lower for current users (HR = 0.81; 95% CI, 0.73-0.91) compared with former users (HR = 0.92; 95% CI, 0.84-1).
“We saw that among women who took contraceptive pills, the risk of developing RA was 19% lower than among those who had never taken this type of drug,” Hadizadeh said in a press release from Uppsala University. “Even after the women had stopped taking contraceptive pills, we saw an 11% lower risk of developing RA.”
Meanwhile, the researchers found that women with MHT history had an increased risk for late-onset RA (HR = 1.16; 95% CI, 1.05-1.26), compared with those who never received MHT. This finding was consistent among both the initial white cohort and among the more diverse ethnic groups. The risk for late-onset RA was also higher for former users of MHT (HR = 1.13; 95% CI, 1.03-1.24).
The study’s limitations include U.K. Biobank participants being healthier than the general U.K. population. In addition, RA diagnosis data were partly self-reported and information was unavailable on the formulations of hormones and how they were administered, according to the researchers.
“The results may lead to better-informed recommendations to women who have a heightened risk of suffering from rheumatoid arthritis,” Weronica E. Ek, MSc, lead study author and a researcher at Uppsala University, said in the press release. “The new knowledge could also play a role in the development of new drugs.”
References:
Contraceptive pills protect against rheumatoid arthritis. https://www.medfarm.uu.se/news/news-item/?id=21050&typ=artikel. Published Oct. 11, 2023. Accessed Nov. 1, 2023.
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