Most Read Articles
Tristan Manalac, 2 days ago
Of the newly identified genetic loci for primary angle-closure glaucoma (PACG), two are significantly associated with primary angle-closure suspect (PACS), indicating involvement in the earlier stages of the disease, a recent Singapore study has shown.
5 days ago
Use of proton pump inhibitors (PPIs), even at higher cumulative levels, does not increase the risk for dementia, a recent study has shown.
11 Feb 2018
In males with primary or secondary hypogonadism (HG), adherence to topical testosterone therapy (TTh) appears to improve total testosterone and decrease the risk of conditions associated with HG, a recent study has shown.
5 days ago
Persons with congenital heart disease (CHD) are at a higher risk of dementia, particularly early-onset dementia, than the general population, a recent study has shown.

Oral contraceptive use reduces RA risk

Audrey Abella
29 Dec 2017

The use of oral contraceptives reduces the risk of developing rheumatoid arthritis (RA), especially ACPA*-positive RA, according to the Swedish EIRA** study.

Responses from 6,892 women aged ≥18 years (2,641 cases and 4,251 controls) were gathered to evaluate lifestyle and environmental exposures including oral contraceptive use, breastfeeding, and potential confounders. Sixty-six percent of the cases were ACPA-positive. [Ann Rheum Dis 2017;76:1845-1852]

Compared with never users, ever and past oral contraceptive users had a decreased risk of developing RA overall (odds ratios [ORs], 0.87 for both) and ACPA-positive RA (OR, 0.84 and 0.83 for ever and past users, respectively).

Additionally, longer oral contraceptive use (>7 years) was found to be associated with a decreased risk of RA overall (OR, 0.81; p=0.0014) and ACPA-positive (OR, 0.80; p=0.0037) and ACPA-negative RA (OR, 0.82; p=0.0356) compared with never use, which further reflects the inverse relationship between oral contraceptive use and the subsequent development of RA, said the researchers.

Moreover, there was a significant interaction between smoking and the lack of oral contraceptive use, showing a more pronounced risk among smokers who have never used oral contraceptives (AP***=0.28). This finding validates smoking as a risk factor for ACPA-positive RA. [Rheum Dis Clin North Am 2012;38:405-426; Ann Rheum Dis 2011;70:508-511; Rheumatology 2012;51:499-512].

However, as smoking and oral contraceptive use have been linked to an increased odds of venous thrombotic events (VTE), women who smoke and have a history of VTEs might have been recommended against the use of oral contraceptives, the researchers pointed out. “We can therefore not exclude the possibility that our findings … merely reflect that women [who smoke], who have an increased RA risk, do not receive [oral contraceptive] prescription as often.”

Overall, these findings may provide useful information on certain mechanisms involved in the development of RA which, although one of the most common autoimmune diseases, has a complex pathophysiology involving an interplay of genetic and environmental factors. [Lancet 2009;373:659-672]

While the findings are consistent with previous studies, [J Rheumatol 2004;31:207-213; Ann Rheum Dis 2001;60:934-939] these also contradicted other trials showing a protective effect of oral contraceptive use on the risk of RA when seropositivity was taken into account. [J Rheumatol 2004;31:207-213; Scand J Rheumatol 2010;39:454-460; Arthritis Res Ther 2006;8:R133].

Further trials are therefore warranted to validate these contradictory results and to investigate the biological mechanisms that could elucidate these findings and determine whether hormonal factors influence the RA ACPA subsets, said the researchers.

 

Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Doctor - Malaysia digital copy today!
DOWNLOAD
Editor's Recommendations
Most Read Articles
Tristan Manalac, 2 days ago
Of the newly identified genetic loci for primary angle-closure glaucoma (PACG), two are significantly associated with primary angle-closure suspect (PACS), indicating involvement in the earlier stages of the disease, a recent Singapore study has shown.
5 days ago
Use of proton pump inhibitors (PPIs), even at higher cumulative levels, does not increase the risk for dementia, a recent study has shown.
11 Feb 2018
In males with primary or secondary hypogonadism (HG), adherence to topical testosterone therapy (TTh) appears to improve total testosterone and decrease the risk of conditions associated with HG, a recent study has shown.
5 days ago
Persons with congenital heart disease (CHD) are at a higher risk of dementia, particularly early-onset dementia, than the general population, a recent study has shown.