Abstract
BackgroundWomen are more affected by rheumatoid arthritis (RA) than men and the incidence of RA in women increases around the age of menopause indicating that hormonal factors may have a role in disease pathogenesis and progression. Despite several studies on the role of sex hormones and oral contraceptives (OCs) in RA patients, the effect of combined oral contraceptives on RA disease activity is still controversial, and since few studies have been performed in Egypt on this issue so we aimed to study the effect of OCs, breastfeeding, and prolactin on disease activity and their relation to the titer of autoantibodies in female Egyptian RA patients.ResultsOne hundred twenty married female RA patients were classified into three groups based on the OCs use (n = 40 each); current, past and non-users and according to lactation into three groups; lactating using OCs (n = 22), lactating not using OCs (n = 30), and non-lactating (n = 68). Our patients were using combined estrogen-progestin oral contraceptives. Clinical manifestations, disease activity, and laboratory findings were determined. The clinical manifestations including arthritis, and morning stiffness were significantly reduced in current users in comparison to past and non-users. Mean DAS28 was reduced significantly (p < 0.05) in current and past users of OCs. Also, using OCs during lactation reduced the clinical manifestations significantly. Lactating women who were not using OCs had significantly high DAS28 and ESR (p < 0.05) in comparison to lactating using OCs and non-lactating. On the other hand, using OCs reduced serum prolactin significantly. Lactating women not using OCs had significantly high serum prolactin (p < 0.05) and (p < 0.001) in comparison to lactating using OCs and non-lactating respectively which was correlated with DAS28 score.ConclusionOral contraceptives may be considered in RA female patients not only as a suitable birth control method but also it has a controlling effect on disease activity even during lactation.MessageOral contraceptives ameliorate disease activity in RA patients
Highlights
Women are more affected by rheumatoid arthritis (RA) than men and the incidence of RA in women increases around the age of menopause indicating that hormonal factors may have a role in disease pathogenesis and progression
It is reported that the incidence of RA in women increases around the age of menopause indicating that hormonal factors may have a role in disease pathogenesis and progression [12]
Despite several studies on the role of sex hormones and oral contraceptives (OCs) in RA patients, their effect is still controversial especially it may be affected by race and environmental circumstances, and since as far as we know, no similar studies have been performed in Egypt yet so we aimed to study the effect of both OCs and breastfeeding on disease activity and their relation to the titer of autoantibodies in RA Egyptian female patients
Summary
Women are more affected by rheumatoid arthritis (RA) than men and the incidence of RA in women increases around the age of menopause indicating that hormonal factors may have a role in disease pathogenesis and progression. It is reported that the incidence of RA in women increases around the age of menopause indicating that hormonal factors may have a role in disease pathogenesis and progression [12]. Hormonal theory may be reinforced by the fact that the incidence of RA decreases during pregnancy and RA women who get pregnant usually have disease remission [13]. The different distribution and character of the autoimmune diseases between genders may be related to sex hormones. It is related to disease relapse which occurs during pregnancy in SLE and lactation in RA patients [15]
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