- Researchers are reporting that hormonal changes
related to menopause and hormone replacement therapy may increase the risk
of developing rheumatoid arthritis.
- Women who have more than four children could also
have a higher risk of developing the painful condition.
- Researchers note that women are two to three
times more likely to develop rheumatoid arthritis, which could explain why
estrogen may be involved in raising the risk.
Having four or more
children, developing early menopause, and
getting hormone replacement therapy are some factors that might contribute to the
development of rheumatoid arthritis in
older women.
That’s according to
a new study published in the journal RMD Open.
Researchers collected
data from 223,526 women who were UK Biobank participants.
The scientists looked at information on hormonal and reproductive factors
related to rheumatoid arthritis.
They reported that a
number of factors increased the risk of developing rheumatoid arthritis, albeit
to different degrees.
The scientists followed
the women for an average of about 12 years. During that time, 3,313 (1.5%)
developed rheumatoid arthritis.
Specifically, the
scientists found the following results:
Pregnancy and
the number of children
There wasn’t a
significant difference between women who had been pregnant and those who had
not.
However, researchers
said there was an association between the number of children and rheumatoid
arthritis risk.
The scientists reported
that women who had four or more children were at higher risk of developing the
disease.
Age at first
period
The researchers used 13
as the reference age of the first period.
They found that women
who were 12 and younger or older than 14 had a higher risk of developing
rheumatoid arthritis.
However, those over age
14 had a more substantial risk than those who were younger than 12.
Menopause-related
risk factors
The researchers reported
that women who were older and had longer childbearing years had a greater risk
of developing rheumatoid arthritis.
Postmenopausal women
were also at a higher risk.
The number of years
between the first period and menopause are
reproductive years. Women who had less than 33 years between the two stages had
a higher risk of rheumatoid arthritis.
The researchers also
found that women who had a hysterectomy or oophorectomy had a
higher risk.
Exogenous
hormone use
The scientists did not
find a direct link between oral contraceptives and
rheumatoid arthritis.
However, they reported
an association between the length of time the women took the contraceptives
compared to those who had never used them.
Reaction to the
rheumatoid arthritis risk study
“[This is] a fascinating
and novel study exploring the relationship between the hormonal milieu and the
development of RA (rheumatoid arthritis),” said Dr. Kecia Gaither, an OB/GYN
and a specialist in maternal fetal medicine as well as the director of
Perinatal Services/Maternal Fetal Medicine at NYC Health + Hospitals/Lincoln in
the Bronx.
“It is well known that
women are two to three times more likely to develop this disease over men, so
that fact that estrogen may inherently
be involved lends credence to the observation,” Gaither, who was not involved
in the study, told Medical News Today.
“However, there are a myriad number of risk factors
related to RA development besides sex,” she added. “Obesity, prior joint
damage, periodontal disease, tobacco abuse, stress, and low socioeconomic
status (which has stress as an underlying denominator).”
Tailoring treatment for rheumatoid arthritis
Rheumatoid arthritis can show up differently in women
than in men, according to the National Institute of Health.
For example, some people
can have a few stiff joints with mild inflammation. Another person
might have additional inflamed joints.
Triggers can
also be different. One person might find viral infections cause a
flare of symptoms. Another might see the condition develop with stress.
Experts say these
differences mean physicians should tailor treatment to individuals.
“For some women, when
they are faced with menopause and the loss of hormones, specifically estradiol, they may see a
rise in RA symptoms,” said Dr, Michael Krychman, an OB/GYN and the medical director of Women’s Health
Services at MemorialCare Saddleback Medical Center in California.
“It is important for
[healthcare professionals] to look at the complete picture, and while data is
confusing and there may be some conflicting results (some studies show no
exacerbation of RA symptoms during menopause), it remains important to practice
precision and tailor a woman’s specific health plan to her global symptoms,”
Krychman, who was not involved in the study, told Medical News Today.
“I think this
information can be utilized to have more cogent discussions with patients,
particularly those who have a family history of RA and have other associated
risk factors,” Gaither said. “Referral to a rheumatologist, given the
parameters noted in the study and with family history and other noted risk
factors, would be a prudent course of action.”
However, a referral
isn’t the end of the process.
A study published
in the scientific journal PNAS found that “structured
information–sharing networks among clinicians significantly reduce diagnostic
errors and improve treatment recommendations, as compared to groups of
individual clinicians engaged in independent reflection.”
“The importance of
collaboration and data review is essential when you have a chronic medical
condition such as RA,” said Krychman. “As a women’s health menopausal expert, I
collaborate and work closely with my patient’s rheumatologist to tailor her
hormone therapy and analyze her symptoms.”
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