Influence of hormone replacement therapy on disease progression and bone mineral density in rheumatoid arthritis.
OBJECTIVE
Hormone replacement therapy (HRT) is known to exert a positive effect in preventing bone loss and a beneficial effect on the disease activity in rheumatoid arthritis (RA). We evaluated the effects of HRT on bone mineral density (BMD) and on the course of established RA.


METHODS
Eighty-eight postmenopausal women with RA were randomly allocated to receive HRT, vitamin D3, and calcium supplementation or vitamin D3 and calcium supplementation alone for 2 years. The effects of additional HRT on laboratory and clinical measures of disease activity, quality of life, and BMD and on radiographic joint damage were investigated.


RESULTS
Treatment with HRT suppressed signs of inflammation as shown by reduction in erythrocyte sedimentation rate (ESR) (p = 0.025) and an elevation in hemoglobin concentration (p = 0.007), a better clinical outcome assessed by response on the Disease Activity Score 28 (DAS28) (p = 0.036), increased BMD in the forearm, proximal femur and spine (p < 0.01), and retarded (p = 0.026) progression of joint destruction among patients with radiological progressive disease. No significant effect on quality of life was seen.


CONCLUSIONS
Two years of HRT in women with active RA had significant ameliorating effects on inflammation, DAS28 response, and BMD and was associated with slower progression of radiological joint destruction. The mechanisms by which HRT exerts its effects remain to be elucidated. We suggest HRT can be used in addition to conventional therapy in the management of postmenopausal patients with RA.
D'Elia
Helena Forsblad
HF
Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, Göteborg University, Göteborg, Sweden. helena.forsblad@rheuma.gu.se
Larsen
Arvi
A
Mattsson
Lars-Ake
LA
Waltbrand
Eva
E
Kvist
Göran
G
Mellström
Dan
D
Saxne
Tore
T
Ohlsson
Claes
C
Nordborg
Elisabeth
E
Carlsten
Hans
H
D015502:Absorptiometry, Photon; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D001799:Blood Sedimentation; D015519:Bone Density / Q000187:drug effects*; D001842:Bone and Bones / Q000187:drug effects / Q000378:metabolism; D018450:Disease Progression; D015914:Estrogen Replacement Therapy; D005260:Female; D006304:Health Status; D006801:Humans; D007596:Joints / Q000187:drug effects / Q000503:physiopathology; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D012720:Severity of Illness Index; D016037:Single-Blind Method; D011795:Surveys and Questionnaires