Background/Purpose: Data on the effects of oral contraceptives (OC) on the course of inflammatory arthritis (IA) are controversial. However, a recent analysis of data from the Norfolk Arthritis Register (NOAR) showed that the use of OC is associated with beneficial functional outcomes. We aimed at investigating the associations between OC use, need of therapies, and outcomes in women with early IA within the first year of care.

Methods: A total of 324 women with early IA (symptoms <6 months, 18 - 60 years, never having used hormone replacement therapy), were followed with respect to disease activity (CRP, ESR, S/TJC28, morning stiffness), use of DMARDs and glucocorticoids (GC) and patient-reported outcomes (PROs) according to the Rheumatoid Arthritis Impact of Disease Score (RAID 0-10), the PROFAD (0-10), the PHQ9 Depression Scale (0-27), and the Functional Scale FFbH (0-100). Use of OC was reported as never, past, or current. Outcomes by use of OC were adjusted for age, body mass index, number of natural children, and years of education using generalized linear models.

Results: At baseline, mean age was 46 ±10 years and symptoms lasted for 13 ±7 weeks. Of these women, 68% fulfilled the 2010 criteria for rheumatoid arthritis (RA), 82% were clinically diagnosed with RA at 12 months and 89% took DMARDs at that point in time. 24% had never used OC, 57% had used them in the past, and 19% used them currently. Current users were younger (36 vs. 50 yrs) and less frequently mothers than past and never users (58 vs. 80%). Independent of the time point (t0, 3, 6, 12 months), current use of OC, compared to past and never use, was not associated with biomedical measures, duration of morning stiffness or DMARD use (not shown). However, current and past OC use was associated with steadily decreasing GC use (54 and 57% at 12 months), while never users remained unaltered at 74% (P 0.016). Finally, current and past OC use was associated with significantly better outcomes in almost all considered patient-reported dimensions, such as pain, fatigue, well-being and function (Table). The effect of OC on PROs was, notably, almost the same in past and current users, although half of the past users were older than 50 years and might not have used OC for several years.

PROs at 12 months by use of oral contraceptives (means)

OC use	n	Pain*	Overall fatigue	Problems getting started	Problems to focus	Problems daily chores	Physical well being	Mental well being	Depression (PHQ9 0-27)	Physical function (0-100)
never	88	3.9	4.4	4.1	3.5	3.6	4.4	4.5	6.7	78.7
past	184	3.1	3.5	2.4	2.4	2.6	3.1	2.9	5.1	86.7
current	52	2.8	3.2	1.6	1.5	2.4	2.9	2.3	4.0	87.5
Total	324	3.3	3.7	2.5	2.3	2.8	3.3	3.1	5.2	85.1
P#		0.033	0.049	0.006	0.001	0.012	0.005	<0.001	0.021	0.018

*Means adjusted for age, BMI, number of children and education;^#P never vs. current use

Conclusion: Our findings confirm that women with past or current OC use have better functional outcomes without having less signs of inflammation. The specific spectrum of obviously ameliorated conditions indicates that estrogens seem to have neuro- and psycho-protective effects on many symptoms that compromise well-being in IA. It may be suggested that OC act directly at CNS cytokines rather than influencing the course of peripheral inflammation. Long-lasting programming of CNS function may explain positive effects of OC. The use of hormones should be routinely reported in studies observing IA.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/significantly-less-glucocorticoids-and-better-patient-reported-outcomes-in-women-with-early-inflammatory-arthritis-using-oral-contraceptives-compared-to-never-users/