Can oestrogens be used as adjuvant therapy in female patients with rheumatoid arthritis?

In this review the arguments for a relation between female sex hormones and rheumatoid arthritis are discussed. Clinical evidence includes a relation between disease activity and menstrual cycle and a clear decrease in disease activity during pregnancy. A protective effect of oral contraceptives on the development of rheumatoid arthritis is claimed. There are conflicting data with regard to the plasma levels of sex hormones in women with rheumatoid arthritis. In vitro gonadal hormones suppress T-lymphocyte proliferation, while B-lymphocyte differentiation is enhanced by oestrogens and diminished by testosterone. Some pilot studies suggest that oestrogens may ameliorate disease activity in women with active rheumatoid arthritis. Presently we are conducting a randomized, double-blind trial comparing oestrogens with placebo as adjuvant therapy in women with rheumatoid arthritis.