Background: Hand osteoarthritis (hand OA) mostly occurs in women around the time of menopause, but its relationship with sexual hormones remains a controversial issue. The eventual influence of hormone replacement therapy (HRT) on the incidence and progression of hand OA is still debated.
Objective: To assess whether HRT influences the occurrence and disease activity of hand OA.
Methods/patients: Epidemiological prospective cross-sectional study.
Patients: Menopausal women, aged 50-75, consulting for painful hand OA, for another rheumatic condition with hand OA or controls (no disease of the upper limbs).
Eligibility criteria: hand OA [American College Rheumatology (ACR) criteria] with X-ray evidence. PATIENTS with 'painful' hand OA defined by a Dreiser's functional index score > or = 6 and pain on VAS > or = 35 mm. Study parameters: Demographics, personal histories and gynaecologic data for patients and controls including the administration of HRT (+) or not (-). For patients, description and symptom activity of hand OA.
Statistics: Descriptive analysis in the studied population and in subsets taking into account treatment and disease activity factors.
Results: 711 women were studied: 238 with 'painful' hand OA, 240 with 'quiescent' and 233 controls. Baseline characteristics were similar for patients and controls except for age (patients were older). HRT+ patients were younger (-5 years) (P < 0.0001), slightly taller (P < 0.0045) and more often cigarettes smokers (P < 0.012) than HRT- patients. They did not differ in gynecologic characteristics with the exception that the women in the HRT+ group had been menopausal for a shorter period of time, probably because of their younger age. There were no differences between HRT+ and HRT- patients, whatever the symptom activity, on the characteristics of hand OA: Dreiser's index scores were, respectively, 11.3 +/- 3.8 vs 12.3 +/- 4.5 in 'painful' patients, 3.6 +/- 2.5 vs 3.7 +/- 2.7 in 'quiescent' patients. Pain on VAS showed no difference between the two groups.
Conclusion: Few differences were found between hand OA patients receiving HRT or not. HRT did not seem to influence the severity or the symptom activity of hand OA. Further prospective studies are required in order to evaluate the exact effect of HRT on hand OA.