Effects of cumulative lifetime estrogen exposure on the clinical characteristics and courses in postmenopausal women with rheumatoid arthritis
Authors' conclusion
Patients with RA and lower CLEE had higher disease activity, more erosive disease, and worse PROs than those with a higher CLEE. Lower CLEE adversely affects longitudinal changes in disease activity and PROs and is associated with a lower likelihood of achieving clinical remission in RA.
Study context
- Population
- Postmenopausal women with rheumatoid arthritis (RA) from the Korean Observational Study Network for Arthritis Cohort
- Participants
- 2,878 women
- Exposure
- Lower vs higher cumulative lifetime estrogen exposure
- LOWER cumulative lifetime estrogen exposure (CLEE)n = 1,602
- HIGHER CLEEn = 1,179reference
- Outcome
- Course of RA (disease activity, PROs, remission) by CLEE
- Follow-up
- 5 years
Methodological detailsmulticentre registry cohort (KORONA), 5-year follow-up, adjusted for confounders
- Multicentre registry cohort (KORONA)
- 5-year follow-up
- Adjusted for confounders
Main finding
As reported in the abstract
Disease activity, radiographic erosion and PROs at baseline
- Lower CLEE: worse patient-reported outcomes (PROs) for pain, fatigue, sleep disturbance, functional disability, health-related quality of life and global assessment of RA
- all P < 0.01
Observational data: associations, not effects.
Further findings
| Outcome | aHR for achieving remission (95% CI) | P value | |
|---|---|---|---|
| Remission in patients with SDAI>11 at baseline (subgroup) | 0.597 (0.421–0.848) | P = 0.004 | |
| 0.512AHR for achieving remission (log scale) |
- Remission in patients with Simplified Disease Activity Index (SDAI)>11 at baseline (subgroup): adjusted for confounders; lower CLEE significantly less likely to achieve remission
Baseline disease activity, radiographic erosion and PROs (pain, fatigue, sleep disturbance, functional disability, health-related quality of life, global assessment of RA)
- Lower CLEE: significantly higher disease activity and more radiographic erosion than higher CLEE
- Lower CLEE: worse PROs than higher CLEE (all P < 0.01)
Original publication
Effects of cumulative lifetime estrogen exposure on the clinical characteristics and courses in postmenopausal women with rheumatoid arthritis. Semin Arthritis Rheum. Published 19 July 2025. doi:10.
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