Ask the Expert: Preventing RA Symptoms with Birth Control Pills?

Health Professional

Dear Dr. Borigini,

I'm newly diagnosed with Rheumatoid Arthritis. After doing only preliminary reading, it seemed that there is evidence that changes in hormones estrogen/progesterone can cause the onset of RA symptoms — i.e., following childbirth and remission of symptoms during pregnancy. If this is true, couldn't hormone therapy in the form of birth control pills help in the reduction or elimination of symptoms after RA onset?

Pregnancy in most cases is associated with remission of rheumatoid arthritis, but at least 25% of patients continue to have active disease, or even worsening of disease. In general, those patients who do improve during pregnancy relapse in the postpartum period. It is assumed that hormonal immunologic changes during pregnancy can explain this, but over the years the exact mechanism has not been well-established. There was research data published in the July issue of the scientific journal Arthritis and Rheumatism which found that fetal DNA levels in the blood of mothers who improved during pregnancy was higher compared to the mothers who did not improve during pregnancy. Three to four months after delivery, 90% of the mothers who had improved were suffering from active rheumatoid arthritis; when the mothers' blood was analyzed at that point, the fetal DNA was almost non-existent. So, it appears that the fetal DNA might affect the immune system in a positive way, allowing for remission during pregnancy.

The effect of birth control pills and estrogen replacement on the risk of rheumatoid arthritis was studied, the results published in the Journal of Rheumatology in 2004. The authors found that exposure to birth control pills, but not estrogen replacement therapy, significantly reduced the risk of developing rheumatoid arthritis; this risk appeared even lower during the era when birth control pills contained higher amounts of estrogens and progestins. However, this protective effect is not guaranteed, and no one is recommending that women take birth control pills solely to avoid rheumatoid arthritis.

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