Effects of cumulative lifetime estrogen exposure on the clinical characteristics and courses in postmenopausal women with rheumatoid arthritis

초록

Objectives: To assess the effect of cumulative lifetime estrogen exposure (CLEE) on the course of rheumatoid arthritis (RA). Methods: A total of 2878 postmenopausal women with RA from the Korean Observational Study Network for Arthritis Cohort were investigated at baseline and followed for 5 years. CLEEs were calculated by combining the reproductive span and duration of postmenopausal hormone replacement therapy. Patients with RA were classified into higher and lower CLEE groups using a median of 34 years. Results: Patients with RA and a lower CLEE (n = 1602) showed significantly higher disease activity and more radiographic erosion than those with a higher CLEE (n = 1179) at baseline. The lower CLEE group demonstrated worse patient-reported outcomes (PROs) for pain, fatigue, sleep disturbance, functional disability, health-related quality of life, and global assessment of RA than the higher CLEE group at baseline (all P < 0.01). The lower CLEE group showed increased Simplified Disease Activity Index (SDAI) and Health Assessment Questionnaire-Disability Index scores and decreased EQ-5D-utility values over 5 years after adjusting for confounders. Among patients with RA and an SDAI>11 at baseline, the lower CLEE group was significantly less likely to achieve remission after adjusting for confounders (HR, 0.597 [95% CI 0.421–0.848], p = 0.004). Conclusions: Patients with RA and lower CLEE had higher disease activity, more erosive disease, and worse PROs than those with a higher CLEE. Lower CLEE adversely affects longitudinal changes in disease activity and PROs and is associated with a lower likelihood of achieving clinical remission in RA. © 2025 Elsevier Inc.

키워드