The connection between inflammatory arthritis and levels of circulating estrogen is a topic of recent interest. Incidence rates of rheumatoid arthritis (RA) appear to vary across the lifespan, despite changes in hormonal cycle. However, the increased incidence of RA in women suggests that estrogen may influence the pathogenesis of inflammation in RA.
To study the impact of estrogens in hormonal oral contraceptives (OCs) taken prior to the onset of RA, Katinka Albrecht, MD, and colleagues from the German Rheumatism Research Centre and Charité University Hospital, Berlin, Germany, analyzed results from the Course And Prognosis of Early Arthritis (CAPEA) cohort, a large prospective, multicenter, observational study investigating the predictive value of early RA symptoms in those who had RA for <6 months.1 Exposure to OCs and hormonal replacement therapy was reported as “never,” “past,” or “current” in the trial.
Population data including age, sex, body mass index, and smoking history were collected. Data on disease markers, including erythrocyte sedimentation rate, tender joint count in 28 joints, disease activity score in 28 joints (DAS28), morning stiffness (on the numeric rating scale 0-10), and medication use, including disease-modifying antirheumatic drugs (DMARDs), biologics, glucocorticoids, and nonsteroidal anti-inflammatory drugs (NSAIDs), were collected.
Self-reported measures of disease activity including pain on a numerical rating scale, Rheumatoid Arthritis Impact of Disease score (RAID), Profile of Mood and Discomfort (PROFAD) score, Rheumatoid Arthritis Disease Activity Index (RADAI), and Hannover Functional Assessment (FFbH) were also analyzed.
The researchers found that, at 12 months, current or past OC use was associated with improved RAID, PROFAD, RADAI, and FFbH scores (P < .05 for all scores). Improvements in RAID scores persisted up to 24 months in women with current or past OC use compared with women with no history of OC use (P < .001). Women who had current or past OC use also had improvements in DAS28 scores compared with those who had no history of OC use (P = .028).
Erythrocyte sedimentation rate was not found to be associated with current or past OC use. Treatment frequency with DMARDs, biologics, or NSAIDs also was not associated with a history of current or past OC use.
Summary and Clinical Applicability
Based on the results of this study, current or previous use of OCs appears to be associated with improvements in measures of RA disease activity when measured by self-reported scores such as RAID, PROFAD, RADAI, and FFbH, as well as DAS28.
The authors state that, “the positive effects of past or current OC use on patient-reported outcomes within the first 2 years after the onset of inflammatory arthritis may be explained by long-lasting programming of central nervous system function. This association needs to be confirmed in further studies before any clinical conclusion can be drawn.”
1. Albrecht K, Callhoff J, Buttgereit F, Straub RH, Westhoff G, Zink A. Association between the use of oral contraceptives and patient-reported outcomes in an early arthritis cohort. Arthritis Care Res (Hoboken). 2016;68(3):400-405.