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Does estrogen replacement therapy protect against rheumatoid arthritis?
T D Spector1, P Brennan, P Harris
1Department of Rheumatology, St. Bartholomew's Hospital, London, UK.
The Journal of Rheumatology
|October 1, 1991
Summary
Estrogen replacement therapy (ERT) use did not show a reduced incidence of rheumatoid arthritis (RA) in women aged 35-64. Higher RA rates in ERT users suggest potential self-selection bias among those with undiagnosed joint symptoms.
Area of Science:
- Rheumatology
- Endocrinology
- Epidemiology
Background:
- Estrogen replacement therapy (ERT) is used for menopausal symptoms.
- Previous studies suggested ERT might reduce rheumatoid arthritis (RA) risk.
- The relationship between ERT and RA requires further investigation.
Purpose of the Study:
- To compare RA incidence in women using ERT versus a general population cohort.
- To re-evaluate the potential protective effect of ERT on RA development.
Main Methods:
- A cohort study comparing 1,075 ERT users with 3,251 women from general practice registers.
- Women aged 35-64 were observed between 1982 and 1986.
- RA incidence rates and relative risks for ERT users were calculated.
Main Results:
- RA incidence rates were 19.7/10,000 person-years for ERT users and 12.3/10,000 person-years for controls.
- The relative risk for RA in ERT users was 1.62, not showing a reduction.
- Adjusting for confounders reduced the relative risk towards unity.
Conclusions:
- This study does not support a reduced RA incidence with ERT use.
- Higher incidence in ERT users may be due to self-selection of individuals with pre-existing joint symptoms.
- The complex relationship between ERT and RA warrants careful consideration of confounding factors.