Contraceptive pill is linked to lower risk of rheumatoid arthritis, study findsBMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3925 (Published 18 August 2017) Cite this as: BMJ 2017;358:j3925
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Oral contraceptives, rheumatoid arthritis and immune disorders Re: Contraceptive pill is linked to lower risk of rheumatoid arthritis, study finds
Oral contraceptives, rheumatoid arthritis and immune disorders
Gareth Iacobucci’s Research News, “Contraceptive pill is linked to lower risk of rheumatoid arthritis, reports that Orellana and colleagues found long-term ever users of oral contraceptives (for >7 years) were significantly less likely to have rheumatoid arthritis than never users but they had also said that firm conclusions about cause and effect could not be drawn because the study was observational.1,2
Importantly, Orellana and colleagues merely “adjusted for” the use of menopausal progestogens and oestrogens. Although 33% of cases and 30% of controls reported never using oral contraceptives, at average age 51-52 years, recent use of HRT was more likely. Identical or similar progestogens have been used for both contraception or combined HRT. Therefore, a crucial question is how many study controls were genuine never ever users of hormones?
The main reasons for intolerance to longer use of progestogens and oestrogens is the development of vascular and mental diseases and cancers. Steroids use can suppress warning symptoms while causing biochemical perturbations of normal homeostatic safety mechanisms.3 Autoimmune diseases have been increasing dramatically in young women. Systemic lupus, increased from 1·51 per 100 000 in 1950–79 to 124·0 per 100 000 in 1995, suggesting that contraceptive pills and hormone-replacement therapy are main causes. The commoner antiphospholipid syndrome (APS) has a female /male sex ratio of nine to one. APS usually develops in young women using hormonal contraception and gives them a life times increased risk of thrombosis.4
The Women’s Health Initiative (WHI) randomised double-blind controlled trials of progestogen and/or oestrogen use as HRT were prematurely terminated because of unacceptable increases in heart attacks, strokes, venous thrombosis, breast and endometrial cancers. Observational studies have been seriously misleading and have encouraged false claims of protection.5
1 Iacobuccie G. Contraceptive pill is linked to lower risk of rheumatoid arthritis BMJ 2017;358:j3925.
2 Orellana C, Saevarsdottir S, Klareskog L, Karlson EW, Alfredsson L, Bengtsson C. Oral contraceptives, breastfeeding and the risk of developing rheumatoid arthritis: results from the Swedish EIRA study. Ann Rheum Dis 2017;358:1. doi:10.1136/annrheumdis-2017211620. http://press.psprings.co.uk/ard/august/ard211620.pdf.
3 Grant, ECG. The pill, hormone replacement therapy, vascular and mood over-reactivity, and mineral imbalance. J Nutr Environ Med. 1998; 8: 105–116.
4 Grant EC. Systemic lupus erythematosus. Lancet. 2001 Aug 18;358(9281):586.
5 Grant EC. Grant Ellen C G. Endometrial cancer with progestagen and oestrogen oral contraceptives. The Lancet Oncology , Volume 16 , Issue 15 , e527
Competing interests: No competing interests