Estrogen replacement therapy and physical function in rheumatoid arthritis.

Area of Science:

• Rheumatology
• Endocrinology
• Women's Health

Background:

• Rheumatoid arthritis (RA) significantly impacts postmenopausal women, leading to functional decline independent of disease activity.
• Estrogen replacement therapy (ERT) is explored for mitigating musculoskeletal issues, but its specific role in RA management is not well-defined.

Purpose of the Study:

• To investigate the association between ERT use and physical function in postmenopausal women diagnosed with RA.
• To evaluate if ERT can help reduce the functional decline often experienced by women with RA after menopause.

Main Methods:

• A longitudinal study utilizing data from the Forward, National Databank for Rheumatic Diseases (2000-2022).
• Matched 1:1 cohort of postmenopausal RA patients initiating ERT versus non-users, analyzing Health Assessment Questionnaire (HAQ) scores.
• Generalized estimating equations (GEE) and propensity score matching were employed for robust statistical analysis, adjusting for multiple covariates.

Main Results:

• ERT use was linked to a modest improvement in physical function, as indicated by HAQ scores (β = -0.02, p<0.001).
• Initiating ERT within five years of menopause demonstrated the most significant functional benefits.
• Sensitivity analyses confirmed these findings and indicated improvements in patient-reported outcomes (PROs).

Conclusions:

• ERT use shows a modest association with improved physical function and PROs in postmenopausal women with RA.
• Early initiation of ERT post-menopause appears to yield the greatest benefits for physical function.
• Further investigation is warranted to clarify the clinical utility of ERT in managing RA.