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Hormone replacement therapy appears to have
no effect on risk and severity of rheumatoid
arthritis
Although rheumatoid arthritis (RA) is more predominant in women,
the reasons for this are unclear. Many
studies have examined the effects of
estrogen on the risk and severity of RA, but
the results are conflicting and
controversial.
A new study using data from the Women’s Health Initiative (WHI)
clinical trials on hormone replacement
therapy found that there were no significant
differences in the risk of developing RA or
the severity of RA between postmenopausal
women who were on hormone replacement
therapy and those who took placebos.
The study was published in the March issue of Arthritis Care &
Research (http://www.interscience.wiley.com/journal/arthritiscare).
The WHI randomized controlled trials included over 27,000
postmenopausal women between the ages of 50
and 79 who took estrogen and progestin,
estrogen alone or a placebo.
Led by Brian Walitt of Washington Hospital Center in Washington,
DC, the current study identified women who
had RA based on whether they reported having
it and were taking prescription medications
to treat it.
Self-reported information about whether women had RA was collected
annually, and they were assessed for disease
severity at the beginning of the study and
after one year.
Measures of self-reported joint pain/stiffness were also collected
at that time and participants were asked to
rate the severity of their symptoms.
The study is the only placebo-controlled trial to evaluate the
effect of hormone replacement therapy on
developing RA and the sixth study to
evaluate the effects of hormone therapy on
how women perceive disease severity.
The results showed that there were 105 new cases and 63 existing
cases of RA. There were no statistically
significant differences on either new RA
cases over an average of five to six years
or on the severity of RA symptoms after one
year.
While earlier studies had suggested that hormones had a protective
effect against developing RA, they were
observational. The current study found no
significant protective benefit from hormones
in preventing RA.
Although the prevalence of RA in the study was about half of what
is found in the general population, this may
be due to the tendency of clinical trials to
recruit healthier patients and the exclusion
of participants taking prednisone, which is
used to treat arthritis.
Although the WHI methodology has many advantages over prior
studies, the sample size for RA was much
less than what would be required to observe
the effect of hormone replacement therapy on
developing RA.
However, it is unlikely that larger studies will be carried out,
due to the health risks of hormone
replacement therapy.
Also, the study relied on self-reported information, and even
though it tried to minimize overreporting by
including only women taking medications for
RA, this approach is not as effective as
performing chart reviews or physical exams.
The authors conclude that “the design of the WHI provided a unique
opportunity to examine the effects of PHT
[postmenopausal hormone therapy] on RA.
Despite the participation of 27,347 women,
there was no statistically significant
evidence of a difference in the hazard of RA
incidence or a difference in RA symptom
severity between the PHT and placebo
groups.”
###
Article: “Effects of Postmenopausal Hormone Therapy on Rheumatoid
Arthritis: The Women’s Health Initiative
Randomized Controlled Trials,” Brian Walitt,
Mary Pettinger, Arthur Weinstein, James
Katz, James Torner, Mary Chester Wasko,
Barbara V. Howard, Arthritis Care &
Research, March 2008.
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