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Logo of annrheumdAnnals of the Rheumatic DiseasesCurrent TOCInstructions for authors
Ann Rheum Dis. Jan 1994; 53(1): 54–57.
PMCID: PMC1005244

Effects of hormone replacement therapy in rheumatoid arthritis: a double blind placebo-controlled study.


AIMS--To study the effects of ovarian hormone replacement therapy (HRT) on bone mineral density and disease activity in postmenopausal women with rheumatoid arthritis (RA). METHOD--A placebo controlled double-blind study was carried out on 62 patients with RA, 22 on placebo and 40 on HRT (transdermal oestradiol patches twice weekly for 48 weeks plus norithisterone tablets when clinically indicated). Bone mineral density of spine, hip and wrist was measured at 0 and 48 weeks and clinical and laboratory measures of general well-being and disease activity at 0, 12, 24 and 48 weeks. RESULTS--Thirteen of 22 (59%) of placebo and 31 of 40 (78%) of the HRT group completed 48 weeks in the study. At entry, bone mineral density (BMD) values in the lumbar spine and femoral neck were similar to those in age and sex matched controls in both treatment groups, whereas at the distal radius, BMD was significantly reduced to approximately 50% of control values (both p < 0.001 from controls). In the HRT group, spine BMD increased significantly by a median of +0.94% at 48 weeks (p = 0.024), but did not change significantly in the placebo group. BMD at the femoral neck and distal radius did not change in either group. In the HRT group, there was significant improvement in well being as assessed by the Nottingham Health Care Profile (p < 0.01) and in the articular index (p < 0.05). There were no significant changes in ESR or CRP in either group. CONCLUSION--Transdermal HRT was well tolerated, increased well being, reduced articular index and increased lumbar spine bone density over a one year period in postmenopausal women with RA. Although no laboratory evidence was found of a disease modifying effect, the symptomatic benefits and improvements in bone density indicate that HRT may be a valuable adjunct to conventional antirheumatic therapy in RA.

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  • Hooyman JR, Melton LJ, 3rd, Nelson AM, O'Fallon WM, Riggs BL. Fractures after rheumatoid arthritis. A population-based study. Arthritis Rheum. 1984 Dec;27(12):1353–1361. [PubMed]
  • Spector TD, Hall GM, McCloskey EV, Kanis JA. Risk of vertebral fracture in women with rheumatoid arthritis. BMJ. 1993 Feb 27;306(6877):558–558. [PMC free article] [PubMed]
  • Sambrook PN, Reeve J. Bone disease in rheumatoid arthritis. Clin Sci (Lond) 1988 Mar;74(3):225–230. [PubMed]
  • Lindsay R, Hart DM, Forrest C, Baird C. Prevention of spinal osteoporosis in oophorectomised women. Lancet. 1980 Nov 29;2(8205):1151–1154. [PubMed]
  • Weiss NS, Ure CL, Ballard JH, Williams AR, Daling JR. Decreased risk of fractures of the hip and lower forearm with postmenopausal use of estrogen. N Engl J Med. 1980 Nov 20;303(21):1195–1198. [PubMed]
  • Hazes JM, Dijkmans BA, Vandenbroucke JP, de Vries RR, Cats A. Pregnancy and the risk of developing rheumatoid arthritis. Arthritis Rheum. 1990 Dec;33(12):1770–1775. [PubMed]
  • Vandenbroucke JP, Valkenburg HA, Boersma JW, Cats A, Festen JJ, Huber-Bruning O, Rasker JJ. Oral contraceptives and rheumatoid arthritis: further evidence for a preventive effect. Lancet. 1982 Oct 16;2(8303):839–842. [PubMed]
  • Hernandez-Avila M, Liang MH, Willett WC, Stampfer MJ, Colditz GA, Rosner B, Chang RW, Hennekens CH, Speizer FE. Exogenous sex hormones and the risk of rheumatoid arthritis. Arthritis Rheum. 1990 Jul;33(7):947–953. [PubMed]
  • Bijlsma JW, Huber-Bruning O, Thijssen JH. Effect of oestrogen treatment on clinical and laboratory manifestations of rheumatoid arthritis. Ann Rheum Dis. 1987 Oct;46(10):777–779. [PMC free article] [PubMed]
  • Hunt SM, McKenna SP, McEwen J, Williams J, Papp E. The Nottingham Health Profile: subjective health status and medical consultations. Soc Sci Med A. 1981 May;15(3 Pt 1):221–229. [PubMed]
  • Stevenson JC, Cust MP, Gangar KF, Hillard TC, Lees B, Whitehead MI. Effects of transdermal versus oral hormone replacement therapy on bone density in spine and proximal femur in postmenopausal women. Lancet. 1990 Aug 4;336(8710):265–269. [PubMed]
  • Sambrook P, Birmingham J, Champion D, Kelly P, Kempler S, Freund J, Eisman J. Postmenopausal bone loss in rheumatoid arthritis: effect of estrogens and androgens. J Rheumatol. 1992 Mar;19(3):357–361. [PubMed]
  • van den Brink HR, Lems WF, van Everdingen AA, Bijlsma JW. Adjuvant oestrogen treatment increases bone mineral density in postmenopausal women with rheumatoid arthritis. Ann Rheum Dis. 1993 Apr;52(4):302–305. [PMC free article] [PubMed]
  • Selby PL, Peacock M. Dose dependent response of symptoms, pituitary, and bone to transdermal oestrogen in postmenopausal women. Br Med J (Clin Res Ed) 1986 Nov 22;293(6558):1337–1339. [PMC free article] [PubMed]

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