Birth control pill prevent rheumatoid arthritis

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

The role of oral contraceptives as either an instigating or protective element in rheumatoid arthritis has been controversial. Recent studies have suggested that oral contraceptive (OC) use may reduce the occurrence of rheumatoid arthritis.

Two studies showed a 40 to 50 percent reduction in the risk of premenopausal rheumatoid arthritis in OC users.

(Wingave SJ. Reduction in incidence of rheumatoid arthritis associated with oral contraceptives: Royal College of General Practitioners’ Oral Contraception Study. Lancet 1978;1:569-571.
Vandenbroucke JP, Boersma JW, Festen JJM, et al. Oral contraceptives and rheumatoid arthritis: further evidence for a preventive effect. Lancet 1982;2:839-842).

A population based case-control study reported in the Journal of Rheumatology showed that women who had ever used oral contraceptives had a 44% reduced risk of developing rheumatoid arthritis compared with those who never used them. The use of postmenopausal estrogen replacement therapy (ERT) was not significantly associated with a rheumatoid arthritis risk reduction.

US researchers identified from the medical records of residents of Rochester, Minnesota, 445 female patients who met the 1987 American College of Rheumatology criteria for rheumatoid arthritis (RA) from 1955 to 1994. The control group comprised 445 residents (mean age of 58 years for both groups) of Rochester, Minnesota without RA who were individually matched to the patients. A statistically significantly higher proportion of RA patients smoked compared with the controls (45% vs 37%).

The incidence of OC use in women who developed RA was 11% compared to 16% in controls. Analyses adjusted for age and smoking status showed that ever-use of OCs was associated with a significant 44% risk reduction of RA (95% CI, 0.34-0.92). This finding was also independent of ERT use.

Oral contraceptive use reduced the risk of development of RF positive RA by 64% (95% CI, 0.18-0.72) and reduced the risk of RF negative RA by 2% (95% CI, 0.46-2.10).

Exposure to OC before 1970 was associated with an even lower risk of RA. Although OC use was low prior to 1970 (1% of RA cases and 2% of controls), the risk reduction in women who used OCs before 1970 was about 75%.

Postmenopausal ERT use did not have a significant effect on RA development. Adjustment for age, smoking status, and OC use did not alter the lack of effect of ERT on RA development.

According to population attributable-risk estimates, the prevalence of OC exposure, and the protective effect of OC exposure, the authors concluded that the protective effect of OC exposure on RA development explains only a small portion of the decrease in incidence of RA over the past few decades. The majority of the decrease remains unexplained.

The authors concluded, "Our study, the design of which minimized many of the biases of previous case-control studies that examined this question, finds evidence for a strong protective effect of OC exposure on the development of RA. However, this effect does not appear to explain the declining incidence of RA in women."

(Doran MF, Crowson CS, O'Fallon M, Gabriel SE. The effect of oral contraceptives and estrogen replacement therapy on the risk of rheumatoid arthritis: a population based study. The Journal of Rheumatology. 2004; 31: 207-13.)

Of note... some medicines used to treat rheumatoid arthritis, such as minocycline, may reduce the effectiveness of oral contraceptives.

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