Early Menopause, HRT May Raise Risk

To study the issue, the team of researchers used 223,526 participants from the UK Biobank who had been followed for, on average, 12 years.

During the course of the study, 1.5% of women developed rheumatoid arthritis. Additionally, after other factors were accounted for, the researchers found that several hormonal and reproductive factors appeared to increase risk. Some of the risk factors identified included:

• Starting periods after age 14 (17%)
• Going through early menopause (46%)
• Having fewer than 33 years between starting periods and going through menopause (39%)
• Having four or more children (18%)
• Having a hysterectomy (40%)
• Having one or both ovaries removed (21%)
• HRT use (46%)

While these findings are significant, according to the authors, they point out that this is an observational study, meaning that they simply looked back at the data to see if there was any link. It is not possible to prove from this study whether hormonal or reproductive factors actually caused women to develop rheumatoid arthritis.

Speaking about HRT in particular, the British Menopause Society told Healthline, “There is no evidence to suggest that the use of HRT affects the risk of developing rheumatoid arthritis, and it does not induce flares in postmenopausal women.

“There is some evidence that hormone therapy may influence joint health,” they went on to say, “with decreased hip and knee joint replacement observed in the Women’s Health Initiative Study. So there may be advantages for women with rheumatoid arthritis in having HRT, which will depend on the woman’s symptoms, bone mineral density, and risk profile.”

However, the authors said that their findings suggest that hormonal and reproductive risk factors should be taken into consideration in women with rheumatoid arthritis. They may provide clues for new targets in the prevention of this disease, they said.

Kecia Gaither, MD, MPH, MS, MBA, FACOG — who is double board certified in OB/GYN and Maternal Fetal Medicine, Director of Perinatal Services/Maternal Fetal Medicine at NYC Health + Hospitals/Lincoln in the Bronx — explained that rheumatoid arthritis has a multifactorial basis. Factors such as genetics, obesity, smoking, periodontal disease, age, lung disease, and possibly hormonal factors all influence its development.

“With that being said, not much would be preventive to disease causation except modifying dietary practices to prevent obesity, smoking cessation, and obtaining good periodontal care,” Gaither, who was not involved in the study, remarked. “The other factors are inherent and/or part of the natural aging process.”

David Karp, MD, PhD — Chief, Rheumatic Services Division at UT Southwestern Medical Center, who also was not involved in the study, added that the strongest modifiable risk factor is smoking.

“Others include being overweight, eating a diet high in saturated fats and carbohydrates, low weekly exercise, and consuming more than one alcoholic drink per day.

“As much as 34% of RA could be prevented with health habits that eliminated these risks,” said Karp.

“It should be noted,” Karp concluded, “that while these epidemiological studies show reduction in the risk of RA in people who practice more of these healthy lifestyle habits, they don’t tell us why. For some of them, there are good biological reasons (e.g., smoking) but for others the mechanisms are unknown.”

New research has found an association between hormonal and reproductive factors and increased risk for the autoimmune disease rheumatoid arthritis in women.

Rheumatoid arthritis tends to be much more common in women than in men.

The study was not structured in a way that would allow researchers to say for certain that these factors did cause the women to develop the disease.

However, the study authors said that their findings could provide clues for ways that may help prevent it.

Experts say many of the factors that influence the development of rheumatoid arthritis — such as genetics and aging — are inherent and can’t be changed.

However, there are certain lifestyle choices — like smoking cessation and obesity prevention — which can help.