Association Between the Use of Oral Contraceptives and Patient‐Reported Outcomes in an Early Arthritis Cohort

Abstract

Objective. To evaluate the association between exposure to oral contraceptives (OCs) and clinical outcomes in an early arthritis cohort. Methods. Female patients with early inflammatory arthritis, ages 18-60 years, who were enrolled in an early arthritis cohort and had no exposure to hormone replacement were studied (n 5 273). Associations between OC exposure (current/past/never) and disease activity, treatment, and patient-reported outcomes, including the Rheumatoid Arthritis Impact of Disease Score (RAID), the Rheumatoid Arthritis Disease Activity Index (RADAI), the Profile of Mood and Discomfort (PROFAD), and the Hannover Functional Assessment (FFbH), were studied over 2 years. Linear mixed models adjusted for age, body mass index, parity, smoking, and education were used. Results. Eighteen percent of patients had never used OCs, 63% had used OCs in the past, and 19% currently used OCs. After adjustment, the current/past OC use was associated with better RAID, PROFAD, RADAI, and FFbH scores at 12 months (P < 0.05 for all) compared to never use. Longitudinally over 2 years, the mean RAID scores were significantly better in women with current/past OC use (P < 0.001). Actual inflammatory markers were not associated with OC use. Glucocorticoids were used by a higher percentage of OC never users than by current/past users (P 5 0.08), especially in patients with impaired function (FFbH <70: odds ratio 4.2 [95% confidence interval 1.6-11]). Conclusion. For past as well as current use, OCs seem to moderate patient-reported outcomes in inflammatory arthritis. Protective effects may be induced via central nervous pathways rather than through the suppression of peripheral inflammation.

Effect of oral contraceptive pills on rheumatoid arthritis disease activity in women: A randomized clinical trial

“…It seems that all family planning methods, even intrauterine devices, can be used in patients with RA who are not receiving immunosuppressive therapy. However, still oral contraceptive pills are the best and most effective choice that may have a positive effect on RA development (9). As hormones can apply some immunological changes and rheumatoid arthritis is an autoimmune disease, it is likely that hormones included in oral contraceptive pills can reduce the disease activity and severity (10, 11).…”

Combined oral contraceptive use in rheumatoid arthritis for the purpose of pregnancy prevention and additional benefits: A narrative review

“…Although not clearly defined, it is thought that the estrogen found in COCs may serve as an anti-inflammatory mechanism. 21 This claim appears to be supported by other small sampled studies in which ever-use of COCs tends to have an inverse relationship with the development of and progression of the disease in females, especially those who tend to fall within childbearing age between ages 16 and 40 years old. 22,23 Current evidence from trials suggests that COCs most likely have an additional benefit in females of childbearing age who are at risk of developing RA and those who already have a diagnosis, preventing disease progression by having less radiological joint damage, immobility, and disability, especially with long-term use of COCs.…”

“…Those who have ever used COCs both before diagnosis and after diagnosis of their RA reported better patient outcomes such as inflammation and RAID score (RA impact of disease score), especially in the first few years of their disease progression. Although not clearly defined, it is thought that the estrogen found in COCs may serve as an anti‐inflammatory mechanism 21 . This claim appears to be supported by other small sampled studies in which ever‐use of COCs tends to have an inverse relationship with the development of and progression of the disease in females, especially those who tend to fall within childbearing age between ages 16 and 40 years old 22,23 …”

Geschlechtsspezifische Unterschiede in Diagnostik und Therapie entzündlich-rheumatischer Erkrankungen

“…Die Wirkung der Sexualhormone auf das Schmerzempfinden sowie Unterschiede in der zentralen Schmerzverarbeitung werden als Faktoren mit Einfluss auf die von den Patient:innen angegebenen Schmerzen diskutiert [ 9 ]. Hierzu passen Daten aus der Früharthritiskohorte CAPEA: Frauen, die aktuell oder anamnestisch orale Kontrazeptiva eingenommen hatten, gaben deutlich weniger Schmerzen und Fatigue sowie geringere Funktionseinschränkungen an als Frauen ohne orale Kontrazeption [ 27 ].…”