Estrogen and Other Female Reproductive Risk Factors Are Not Strongly Associated With the Development of Rheumatoid Arthritis in Elderly Women

Linda A. Merlino, James R Cerhan, Lindsey A. Criswell, Ted R. Mikuls, Kenneth G. Saag

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Abstract

Objective: Endogenous and exogenous reproductive hormones have been associated with rheumatoid arthritis (RA) in women, but data are inconsistent and no studies have assessed RA risk factors exclusively in elderly women. Methods: The authors examined the association between reproductive factors, exogenous hormone exposure, and RA in a prospective cohort study of 31,336 Iowa women who were aged 55 to 69 years at cohort baseline in 1986. Results: During 11 years of follow-up, 158 incident cases of RA were identified and validated. Age at last pregnancy (Ptrend = .01) and age at menopause (P trend = .03) were inversely associated with RA, whereas a history of polycystic ovary syndrome (relative risk [RR], 2.58; 95% confidence interval [CI], 1.06 to 6.30), endometriosis (RR, 1.72; 95% CI, 0.93 to 3.18), and former use of hormone replacement therapy (RR, 1.47; 95% CI, 1.04 to 2.06) were positively associated with RA. In multivariate analysis models, a history of polycystic ovary syndrome remained the most consistent predictor of RA, whereas the RRs for other factors attenuated. Conclusion: Few reproductive factors showed a strong or statistically significant association with RA in elderly women. The association of polycystic ovary syndrome may be indicative of perturbations of endocrine-immune activity that may influence the development of RA. This prospective cohort study adds to the understanding of the potential contribution of hormonal factors to the cause of RA in older women.

Original languageEnglish (US)
Pages (from-to)72-82
Number of pages11
JournalSeminars in Arthritis and Rheumatism
Volume33
Issue number2
DOIs
StatePublished - Oct 2003

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Rheumatoid Arthritis
Estrogens
Polycystic Ovary Syndrome
Confidence Intervals
Cohort Studies
Hormones
Prospective Studies
Hormone Replacement Therapy
Endometriosis
Menopause
Multivariate Analysis
Pregnancy

Keywords

  • Estrogen
  • Prospective cohort
  • Reproductive risk factors
  • Rheumatoid arthritis

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Orthopedics and Sports Medicine
  • Rheumatology

Cite this

Estrogen and Other Female Reproductive Risk Factors Are Not Strongly Associated With the Development of Rheumatoid Arthritis in Elderly Women. / Merlino, Linda A.; Cerhan, James R; Criswell, Lindsey A.; Mikuls, Ted R.; Saag, Kenneth G.

In: Seminars in Arthritis and Rheumatism, Vol. 33, No. 2, 10.2003, p. 72-82.

Research output: Contribution to journalArticle

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abstract = "Objective: Endogenous and exogenous reproductive hormones have been associated with rheumatoid arthritis (RA) in women, but data are inconsistent and no studies have assessed RA risk factors exclusively in elderly women. Methods: The authors examined the association between reproductive factors, exogenous hormone exposure, and RA in a prospective cohort study of 31,336 Iowa women who were aged 55 to 69 years at cohort baseline in 1986. Results: During 11 years of follow-up, 158 incident cases of RA were identified and validated. Age at last pregnancy (Ptrend = .01) and age at menopause (P trend = .03) were inversely associated with RA, whereas a history of polycystic ovary syndrome (relative risk [RR], 2.58; 95{\%} confidence interval [CI], 1.06 to 6.30), endometriosis (RR, 1.72; 95{\%} CI, 0.93 to 3.18), and former use of hormone replacement therapy (RR, 1.47; 95{\%} CI, 1.04 to 2.06) were positively associated with RA. In multivariate analysis models, a history of polycystic ovary syndrome remained the most consistent predictor of RA, whereas the RRs for other factors attenuated. Conclusion: Few reproductive factors showed a strong or statistically significant association with RA in elderly women. The association of polycystic ovary syndrome may be indicative of perturbations of endocrine-immune activity that may influence the development of RA. This prospective cohort study adds to the understanding of the potential contribution of hormonal factors to the cause of RA in older women.",
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