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pubmed:otherAbstract |
PIP: In France, researchers compared data on 176 women 25-84 years old who had been diagnosed with rheumatoid arthritis at Gui de Chauliac Hospital in Montpellier and who had had at least 1 birth with data on 145 healthy female controls to examine the influence of oral contraceptives (OCs), breast feeding, and parity on rheumatoid arthritis. Women who used OCs for fewer than 5 years were less likely to develop rheumatoid arthritis than nonusers (adjusted odds ratio [AOR] = 0.713), but the difference was not significant. OC use before onset of rheumatoid arthritis was less common in women with severe rheumatoid arthritis than in those with mild rheumatoid arthritis (21.7% vs. 44%; p 0.0001). OC use of more than 5 years had a protective effect against severe rheumatoid arthritis. When adjusted for age at birth, OC use, and breast feeding, parities 2 and 3 increased the risk of developing severe rheumatoid arthritis 2.9 and 4.8 fold, respectively (p 0.0001). 46% of cases with severe disease had totally breastfed for more than 6 months compared to 26% of those with mild rheumatoid arthritis (p 0.02). After adjusting for age, parity, and OC use, breast feeding duration of more than 6 months did not increase the risk of severe rheumatoid arthritis. Women with severe rheumatoid arthritis were more likely to have breastfed more children than those with mild disease (29% vs. 9%; p 0.008). After adjustment for age at birth, OC use, and parity, having breastfed at least 3 children increased the risk of severe disease (AOR = 1.4). These findings show that parity and, to a lesser extent, breast feeding worsened the prognosis of rheumatoid arthritis, while OC use has a protective effect against severe disease. The underlying mechanisms for these effects may involve prolactin and estrogen but further research in the field of immunoendocrinology is needed to determine the mechanisms.
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