Influence of Hormone Replacement Therapy on Disease Progression and Bone Mineral Density in Rheumatoid Arthritis

HELENA FORSBLAD D'ELIA, ARVI LARSEN, LARS-ÅKE MATTSSON, EVA WALTBRAND, GÖRAN KVIST, DAN MELLSTRÖM, TORE SAXNE, CLAES OHLSSON, ELISABETH NORDBORG, and HANS CARLSTEN

ABSTRACT.

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.

Conclusion. 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. (J Rheumatol 2003;30:1456-63)

Key Indexing Terms:

RHEUMATOID ARTHRITIS
RANDOMIZED CONTROLLED TRIALS
HORMONE REPLACEMENT THERAPY
POSTMENOPAUSAL OSTEOPOROSIS
RADIOGRAPHY
ESTROGEN

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From the Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, Göteborg University, Göteborg, Sweden.

Supported by grants from Regional Research Sources from Västra Götaland, Novo Nordisk Research Foundation, Rune och Ulla Amlövs Foundation for Rheumatology Research, The Research Foundation of Trygg-Hansa, the Swedish and Göteborg Association Against Rheumatism, Reumaforskningsfond Margareta, King Gustav V 80-Years Foundation, The Medical Society of Göteborg, and the Medical Faculty of Göteborg (LUA).

H. Forsblad d'Elia, MD, Department of Rheumatology and Inflammation Research, Göteborg University; A. Larsen, MD, Assistant Professor, Department of Rheumatology, Kongsvinger, Norway; L-Å. Mattsson, MD, Professor, Department of Obstetrics and Gynecology, Göteborg University; E. Waltbrand, MD, Department of Rheumatology, Borås, Sweden; G. Kvist, MD, Department of Rheumatology, Borås, Sweden; D. Mellström, MD, Assistant Professor, Department of Geriatrics, Göteborg University; T. Saxne, MD, Professor, Department of Rheumatology, University of Lund, Sweden; C. Ohlsson, MD, Professor, Department of Internal Medicine; E. Nordborg, MD, Assistant Professor, Department of Rheumatology and Inflammation Research; H. Carlsten, MD, Professor, Department of Rheumatology and Inflammation Research, Göteborg University.

Address reprint requests to Dr. H. Forsblad d'Elia, Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, Guldhedsgatan 10, S-413 46 Göteborg, Sweden. E-mail: helena.forsblad@rheuma.gu.se

Submitted June 6, 2002; revision accepted January 30, 2003.

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