Rheumatoid factor seropositivity is inversely associated with oral contraceptive use in women without rheumatoid arthritis
- Shailaja S Bhatia1,*,
- Darcy S Majka2,*,
- John M Kittelson1,
- Lezlie A Parrish3,
- Elizabeth D Ferucci4,
- Kevin D Deane3,
- William P Arend3,
- Marian Rewers5,
- V Michael Holers3,
- Jill M Norris1
- 1Department of Preventive Medicine and Biometrics, University of Colorado at Denver and Health Sciences Center, Denver, Colorado, USA
- 2Division of Rheumatology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
- 3Division of Rheumatology, University of Colorado at Denver and Health Sciences Center, Denver, Colorado, USA
- 4Office of Alaska Native Health Research, Alaska Native Tribal Health Consortium, Anchorage, Alaska, USA
- 5Barbara Davis Center for Childhood Diabetes, University of Colorado at Denver and Health Sciences Center, Denver, Colorado, USA
- Correspondence to:
Dr Jill M Norris
Department of Preventive Medicine and Biometrics, University of Colorado at Denver and Health Sciences Center, Denver, 4200 East Ninth Avenue, Box B119, Denver, CO 80262, USA;
- Accepted 13 July 2006
- Published Online First 25 July 2006
Objectives: To examine whether oral contraceptive use is associated with the presence of serum rheumatoid factor in women of reproductive age without rheumatoid arthritis.
Methods: 304 women selected from parents of children who were at increased risk of developing type 1 diabetes were studied, because they were enriched with the human leucocyte antigen-DR4 allele, a susceptibility marker for both type 1 diabetes and rheumatoid arthritis. Participants visited a clinic where blood was drawn for rheumatoid factor testing, and exposure data were collected via questionnaires. A medical history and joint examination were performed to rule out rheumatoid arthritis. Participants and examiners were unaware of the participants’ rheumatoid factor status at the time of examination and questionnaire.
Results: Use of oral contraceptives at any time was inversely associated with rheumatoid factor positivity (adjusted odds ratio (OR) 0.2, 95% confidence interval (CI) 0.07 to 0.52) independent of age, education and smoking. Smoking ⩾20 pack-years was also associated with rheumatoid factor positivity (adjusted OR 56.38, 95% CI 4.31 to 736.98) compared with never smoking. Smoking 1–19 pack-years was not associated with a positive rheumatoid factor.
Conclusions: Our results suggest that oral contraceptive use, and possibly cigarette smoking, act early in the development of the immune dysregulation that occurs in rheumatoid arthritis.
- ACR, American College of Rheumatology
- DAISY, Diabetes Autoimmunity Study in the Young
- HLA, human leucocyte antigen
↵* These authors contributed equally to the study.
Funding: These studies were supported by NIH U-19 AI50864, T-32 AR07534, N-01 AR42218, P-60 AR47784, P-30 AR47363, R-01 DK32493 (DAISY), DERC P30 DK57516, Arthritis Foundation/American College of Rheumatology Physician Scientist Development Award, NIH K12 RR017707 (Northwestern University), K23 AR051461 and the Smyth Professorship in Rheumatology.
Competing interests: None.
Published Online First 25 July 2006