A study published this summer in the journal Arthritis and Rheumatism looking at the use of oral contraceptives and improvements in Rheumatoid Arthritis symptoms adds to the evidence suggesting a connection between female hormones and this possible cause of neck pain. Around two-thirds of RA patients suffer from problems in the cervical spine, with the thoracic and lumbar spine usually less affected. Researchers at the University of Manchester in England used data from women with recent onset of inflammatory polyarthritis and assessed the number who had and had not used oral contraceptives since the diagnosis. The data appears to show a connection between better functional outcome in (female) RA patients using oral contraceptives prior to and at the time of diagnosis compared to women who had never used oral contraceptives. The study authors noted however that the significance of the association only stands in those patients with moderate or severe disability at onset, rather than low level functional disability.
What is Rheumatoid Arthritis?
Rheumatoid Arthritis is an inflammatory disorder that produces symptoms of joint pain, fatigue, fever, and even mood disturbances in sufferers. It is associated with an autoimmune dysfunction and is more prevalent in women than in men, with that trend becoming more pronounced in recent years, an effect blamed on an increased proportion of women smoking (despite less people smoking overall), lower vitamin D levels in many women, and the lower doses of oestrogen used in contraceptives. A study published last year found that the disease occurs in around 1.5million Americans and affects their professional and personal lives, as well as being associated with a shorter lifespan; around 70% of those diagnosed with Rheumatoid Arthritis are women. Up to half of all RA patients are prevented from working by their illness withing 10-20 years after initial diagnosis and the condition costs more than $9billion in healthcare costs, and possibly more than $39billion estimated in indirect costs.
Patients with Rheumatoid Arthritis frequently have neck pain, and the condition, along with ankylosing spondylitis and other inflammatory arthropathies is a common cause of cervical spinal dysfunction. Rheumatoid Arthritis has the potential to lead to very serious complications from subluxations at C1-C2 where the spinal cord itself can become compressed and paralysis or permanent nerve and spinal cord damage may occur. Patients with RA and signs of inflammation, joint degeneration, and symptoms at this level may be able to manage the condition with conservative therapy including physical manipulation and non-surgical traction. Neck surgery may be appropriate in some cases to stabilize the cervical spine through spinal fusion.
How Do Oral Contraceptives Affect RA?
The follow-up period for those included in this data-set averaged almost five years and measurements of functional ability were taken during this time. Patients who had used oral contraceptives prior to their diagnosis of RA had better functional outcomes on follow-up than those who had not used OCs prior to diagnosis. The data also showed an association between OC use at the time of diagnosis and improved functional outcome in comparison to no use of OCs at this time. Of course, association does not imply causality and it may be that some other factor, closely aligned with the use of oral contraceptives is in fact responsible for the purported benefit.
The women whose data was used in the study included 663 women who had not used OCs after diagnosis and 265 who had. The researchers also observed better functional outcomes in women who were taking OCs at the start of the study compared to women who had previously taken OCs but were not currently taking them. All of the women in the group who had taken OCs were under fifty years old and had not had a hysterectomy or gone through menopause during the follow-up period.
What Conclusions Can We Draw from the Study?
The overriding message from the study appears to be that young women have little reason to worry about using oral contraceptives as regards the potential ramifications for Rheumatoid Arthritis and may even have improved functional outcomes as a result of the drugs. Clearly there are other concerns for women using oral contraceptives but the effects on RA do not appear to be one of them. The lead researchers, Dr. Symmons noted that the possible biological mechanisms behind the association are intriguing to consider, especially given that the earlier use of OCs appears to have benefits several years afterwards. Certainly the research does not suggest that women are better off using oral contraceptives in comparison to regular medication for Rheumatoid Arthritis, such as methotrexate, however, women who are reticent about taking oral contraceptives for fear of worsening their neck pain from Rheumatoid Arthritis may feel reassured by this study.
Camacho, E. M., Lunt, M., Farragher, T. M., Verstappen, S. M. M., Bunn, D. K. and Symmons, D. P. M. (2011), The relationship between oral contraceptive use and functional outcome in women with recent-onset inflammatory polyarthritis: Results from the Norfolk Arthritis Register. Arthritis & Rheumatism, 63: 2183–2191.
Elena Myasoedova, Cynthia S. Crowson, Hilal Maradit Kremers, Terry M. Therneau, Sherine E. Gabriel. Is the incidence of rheumatoid arthritis rising? Results from olmsted county, minnesota, 1955-2007. Arthritis & Rheumatism, 2010.
Helmick, C.G., Felson, D.T., et al, Estimates of the Prevalence of Arthritis and Other Rheumatic Conditions in the United States, Part I. Arthritis and Rheumatism, Vol. 58, No. 1, January 2008, pp 15–25.