Meta-analysis of oral contraceptives and rheumatoid arthritis risk in women

Qi, Shuang; Xin, Rui; Guo, Weina; Liu, Yan

doi:10.2147/tcrm.s70867

Cited by 12 publications

(7 citation statements)

References 56 publications

(58 reference statements)

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“…Only borderline associations have been observed in a few recent meta-analyses. 22 23 Our results are in agreement with those from Doran et al , 6 who reported a decreased risk among ever (OR=0.57 (95% CI 0.35 to 0.91) but not among current (OR=1.0 (95% CI 0.4 to 2.52) OC users. Another case–control study performed in Sweden showed a non-significant association for ever (OR=0.70, 95% CI 0.40 to 1.24) and current (OR=1.21, 95% CI 0.58 to 2.52) OC users, but the association for past users was significant (OR=0.37, 95% CI 0.16 to 0.86).…”

Section: Discussionsupporting

confidence: 93%

Oral contraceptives, breastfeeding and the risk of developing rheumatoid arthritis: results from the Swedish EIRA study

Orellana

Saevarsdóttir

Klareskog

et al. 2017

Annals of the Rheumatic Diseases

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ObjectivesTo study whether oral contraceptive (OC) use or breastfeeding (BF) influence the risk of rheumatoid arthritis (RA), stratifying the cases by presence/absence of anticitrullinated protein antibodies (ACPA), and whether these factors interact with known risk factors in the development of ACPA-positive RA.MethodsWomen aged ≥18 years, participants in the population-based case–control Swedish Epidemiological Investigation of RA study (2641 cases/4251 controls), completed an extensive questionnaire regarding OC, BF and potential confounders. We calculated ORs, with 95% CIs, adjusted for age, residential area, smoking and alcohol consumption. Attributable proportion due to interaction (AP) was estimated to evaluate presence of interaction.ResultsCompared with never users, ever and past OC users had a decreased risk of ACPA-positive RA (OR=0.84 (95% CI 0.74 to 0.96); OR=0.83 (95% CI 0.73 to 0.95), respectively). No significant associations were found for ACPA-negative RA. Long duration of OC use (>7 years vs never use) decreased the risk of both ACPA-positive (p=0.0037) and ACPA-negative RA (p=0.0356).A history of long BF decreased the risk only of ACPA-positive RA in a dose-dependent manner (p=0.0086), but this trend did not remain after adjustments. A significant interaction was observed between the lack of OC use and smoking (AP=0.28 (95% CI 0.14–0.42)) on the risk of ACPA-positive RA. No interactions were found for BF.ConclusionsOC decreased the risk of RA, especially ACPA-positive RA, where an interaction with smoking was observed. A long duration of OC use decreased the risk of both disease subsets. We could not confirm an association between BF and a decreased risk of either ACPA-positive or ACPA-negative RA.

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Section: Discussionsupporting

confidence: 93%

Oral contraceptives, breastfeeding and the risk of developing rheumatoid arthritis: results from the Swedish EIRA study

Orellana

Saevarsdóttir

Klareskog

et al. 2017

Annals of the Rheumatic Diseases

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“…Some studies have suggested that OC use, especially long-term OC use, is associated with a lower risk of RA 24,28 , but other studies have found that OC use is associated with a higher risk of RA 7,23 . Two meta-analyses published in 2014 failed to demonstrate the protective role of OC in RA development 25,26 , in line with the results of our study.…”

Section: Discussionsupporting

confidence: 92%

“…with RA include age at menarche 7,8 , age at menopause [9][10][11][12] , parity [13][14][15][16][17][18] , breast feeding 8,[19][20][21][22] , use of oral contraceptives (OC) [23][24][25][26][27][28] , and hormonal replacement therapy (HRT) 29,30 . For the development of RA, these factors have been described as protective factors 8,14,18,[20][21][22]24,[27][28][29] , risk factors 9,10,12,15,17,23 , or irrelevant 11,25,26,30 , depending on the study, leading to inconsistent results. Previous literature showed that the effect of parity on RA varies with age 15,18 .…”

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confidence: 99%

Menopausal factors and risk of seropositive rheumatoid arthritis in postmenopausal women: a nationwide cohort study of 1.36 million women

Eun

Jeon

Han

et al. 2020

Sci Rep

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In previous literature regarding development of rheumatoid arthritis (RA), female reproductive factors have been described as protective factors, risk factors, or irrelevant, leading to inconsistent results. The aim of this study was to investigate the effect of female reproductive factors on the incidence of seropositive RA. A large population-based retrospective cohort of the National Health Insurance Service data in South Korea was used. Postmenopausal women who participated in both cardiovascular and breast cancer screening in 2009 were included and followed until date of seropositive RA diagnosis, death, or December 31, 2018. Multivariable-adjusted Cox proportional hazards model was used to assess the association between reproductive factors and incident seropositive RA. Of 1,357,736 postmenopausal women, 6056 women were diagnosed with seropositive RA, and the incidence rate was 54.16 cases/100,000 person-years. Reproductive factors other than hormone replacement therapy (HRT) were not significantly associated with seropositive RA incidence. Postmenopausal women who used HRT ≥ 5 years were associated with a higher aHR of incident seropositive RA than never-users (aHR 1.25; 95% CI 1.09–1.44). Alcohol consumption less than 30 g per day (aHR 0.80; 95% CI 0.74–0.87), regular physical activity (aHR 0.90; 95% CI 0.84–0.97), diabetes mellitus (aHR 0.85; 95% CI 0.78–0.93), and cancer (aHR 0.77; 95% CI 0.64–0.92) were associated with lower risk of seropositive RA. Most female reproductive factors did not significantly affect the development of seropositive RA in postmenopausal women. Only HRT is associated with a small but significant increase in risk of seropositive RA.

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“…This aspect was interesting, as a possible relationship between female sex hormones and susceptibility of rheumatoid arthritis had been reported in the literature, so that low levels of those hormones at menopause promote the risk of developing the disease early [ 60 ]. However, a protective role of oral contraceptives on the risk for rheumatoid arthritis in women is still controversial [ 61 – 63 ]. On the other hand, there is strong evidence that estrogen deficiency influences the severity of periodontitis, since worse periodontal parameters were observed as bleeding on probing, gingival recession, and clinical attachment loss in postmenopausal women with osteoporosis [ 64 ].…”

Section: Discussionmentioning

confidence: 99%

Relationship between Periodontitis and Rheumatoid Arthritis: Review of the Literature

Araújo

Melo

Lima

2015

Mediators of Inflammation

123

115

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Periodontitis (PD) and rheumatoid arthritis (RA) are immunoinflammatory diseases where leukocyte infiltration and inflammatory mediators induce alveolar bone loss, synovitis, and joint destruction, respectively. Thus, we reviewed the relationship between both diseases considering epidemiological aspects, mechanical periodontal treatment, inflammatory mediators, oral microbiota, and antibodies, using the keywords “periodontitis” and “rheumatoid arthritis” in PubMed database between January 2012 and March 2015, resulting in 162 articles. After critical reading based on titles and abstracts and following the inclusion and exclusion criteria, 26 articles were included. In the articles, women over 40 years old, smokers and nonsmokers, mainly constituted the analyzed groups. Eight studies broached the epidemiological relationship with PD and RA. Four trials demonstrated that the periodontal treatment influenced the severity of RA and periodontal clinical parameters. Nine studies were related with bacteria influence in the pathogenesis of RA and the presence of citrullinated proteins, autoantibodies, or rheumatoid factor in patients with PD and RA. Five studies investigated the presence of mediators of inflammation in PD and RA. In summary, the majority of the articles have confirmed that there is a correlation between PD and RA, since both disorders have characteristics in common and result from an imbalance in the immunoinflammatory response.

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Meta-analysis of oral contraceptives and rheumatoid arthritis risk in women

Cited by 12 publications

References 56 publications

Oral contraceptives, breastfeeding and the risk of developing rheumatoid arthritis: results from the Swedish EIRA study

Oral contraceptives, breastfeeding and the risk of developing rheumatoid arthritis: results from the Swedish EIRA study

Menopausal factors and risk of seropositive rheumatoid arthritis in postmenopausal women: a nationwide cohort study of 1.36 million women

Relationship between Periodontitis and Rheumatoid Arthritis: Review of the Literature

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