Outcomes May Be Better in Early RA With Oral Contraceptive Use

Pam Harrison

August 27, 2015

Women with inflammatory arthritis who are currently using oral contraceptives (OCs) or who have used them in the past have better patient-reported outcomes within the first 2 years of being diagnosed with the disease, according to findings from the Course and Prognosis of Early Arthritis (CAPEA) inception cohort.

Katinka Albrecht, MD, from the German Rheumatism Research Centre in Berlin, and colleagues found that both current and past use of OCs had a moderate benefit on some patient-reported outcomes in inflammatory arthritis. Furthermore, glucocorticoids were required by a higher percentage of OC never-users compared with past and current users, especially among those with impaired physical function at baseline.

"The positive effects of past or current OC use on patient-reported outcomes within the first two years after the onset of inflammatory arthritis may be explained by long-lasting programming on [central nervous system] function," Dr Albrecht and colleagues write in an article published online August 4 in Arthritis Care & Research. "This association needs to be confirmed in further studies before any clinical conclusion can be drawn."

The CAPEA inception cohort is a prospective, multicenter observational study investigating the prognostic value of early symptoms for the development of a chronic disease course in patients who have had arthritis for less than 6 months. Between 2010 and 2013, 1301 patients were enrolled from a wide variety of rheumatology clinics in Germany and were followed by a rheumatologist for 24 months.

Some 273 participants were included in the current analysis. The mean age of the cohort was 46 years, and the mean duration of symptoms was only 13 weeks at study entry. The majority of the cohort had been diagnosed with rheumatoid arthritis (RA) by 12 months.

The researchers assessed patients at baseline and at 3, 6, 12, 18, and 24 months, using standardized measures of disease activity including the Disease Activity Score in 28 joints, and for patient-reported outcomes at baseline and at 6, 12, and 24 months.

Patient-reported outcomes included measures of pain on a numeric rating scale, the Rheumatoid Arthritis Impact of Disease Score (RAID), the Profile of Mood and Discomfort, the Patient Health Questionnaire Depression Scale, the Rheumatoid Arthritis Disease Activity Index, and the Hannover Functional Assessment (FFbH). As the authors note, the FFbH is widely used in Germany, and FFbH values can be transformed into Health Assessment Questionnaire values.

The majority of the cohort had been diagnosed with rheumatoid arthritis (RA) by 12 months.

Only 18% of the cohort had never used OCs; 63% of the group had used OCs in the past, and 19% were current OC users.

Some 176 patients reported duration of OC use, and in this group, investigators compared outcomes among women who had taken OCs for fewer than 10 years, for 10 to 20 years, or for more than 20 years.

Results from this analysis showed that there were no associations among duration of OC use and the mean baseline disease activity score in 28 joints, FFbH values, or frequency of patients using glucocorticoids.

In contrast, "women with current and women with past OC use had mean [disease activity score in 28 joints] values overall all time points (3.3±0.1) that were 0.4 units lower than women who had never taken OCs (3.7±0.1, p<0.005)," the authors observe.

Patients who had never used OCs were also 60% more likely to require glucocorticoids than current or past OC users (odds ratio, 1.6; 95% confidence interval, 0.94 - 2.9; P = .08).

No other measures of disease activity were associated with OC use or nonuse, with the exception of the mean tender joint count during the 2 years of follow-up, in which current and past users had significantly fewer tender joints than never-users (P = .08).

In contrast, after adjusting for confounding variables, current and past OC users had significantly better scores on several patient-reported outcomes at 12 months, including RAID, the Profile of Mood and Discomfort, the Rheumatoid Arthritis Disease Activity Index, and FFbH scores (all P < .05), compared with never-users.

Longitudinally, over the course of 2 years, the mean RAID scores were also significantly better in current or past OC users than in never-users (P < .001).

Specifically, past or current OC users had mean RAID values that were 1.1/1.0 units lower than for patients who had never taken OCs (P < .01) over all points of assessment, the investigators add.

As the authors point out, the mechanism by which OCs may mediate mood effects is not clear, but there is evidence that OCs contribute to mood stabilization.

"As mood is captured by [patient-reported outcomes], this may be one mechanism for the association between OC use and [patient-reported outcomes]," they suggest.

The CAPEA cohort was funded by a grant from Pfizer. The authors have disclosed no relevant financial relationships.

Arthritis Care Res. Published online August 14, 2015. Abstract


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.