Rheumatology (Oxford). 2026 Apr 24:keag197. doi: 10.1093/rheumatology/keag197. Online ahead of print.
ABSTRACT
OBJECTIVES: Postmenopausal women with rheumatoid arthritis (RA) experience worsening functional decline, independent of disease activity. Estrogen replacement therapy (ERT) has been proposed to mitigate musculoskeletal deterioration, but its role in RA remains unclear. This study investigated the association between ERT use and physical function in postmenopausal women with RA.
METHODS: This longitudinal study analyzed data from Forward, the National Databank for Rheumatic Diseases (2000-2022). Postmenopausal women with RA who initiated ERT were matched 1:1 to non-users based on menopause year or ERT initiation. The primary outcome was physical function, assessed using the Health Assessment Questionnaire (HAQ). Generalized estimating equations (GEE) were used to evaluate the association between ERT and HAQ scores, adjusting for demographics, reproductive history, RA duration, comorbidities, and medication use. Sensitivity analyses with propensity score matching were conducted.
RESULTS: A total of 8,246 women were included, with 4,123 ERT users matched to non-users. ERT use was associated with modestly improved HAQ scores (β = -0.02, 95% CI -0.03, -0.01; p< 0.001). Later menopause correlated with better function (β = -0.008 per year after menopause, 95% CI -0.03, -0.01; p< 0.001). Women initiating ERT within five years of menopause demonstrated greater benefits. Sensitivity analyses using propensity score adjustment confirmed these findings and revealed additional improvements in patient-reported outcomes (PROs).
CONCLUSIONS: ERT use was modestly associated with improved physical function and other PROs in postmenopausal women with RA, with the greatest benefits seen in early postmenopausal initiation. No excess crude rates of cardiovascular or cancer events were observed. Further research is needed to determine the clinical implications of ERT in RA management.
PMID:42032824 | DOI:10.1093/rheumatology/keag197