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Mahendira D, Thavaneswaran A, Carty A, Haroon N, Anton A, Passalent L, Alnaqbi KA, Savage L, Aslanyan E, Inman RD. Analysis of the effect of the oral contraceptive pill on clinical outcomes in women with ankylosing spondylitis. J Rheumatol 2015; 41:1344-8. [PMID: 24931958 DOI: 10.3899/jrheum.130996] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE There are unexplained sex-specific changes in the clinical expression of ankylosing spondylitis (AS). We sought to examine the potential effect of exogenous estrogen in the form of oral contraceptive pills (OCP) on AS initiation and severity. METHODS This cross-sectional study consisted of women with AS from the membership of the Spondylitis Association of America. Measures of disease severity included use of biological agents and hip replacement surgery, while Bath AS Functional Index (BASFI) scores served as a surrogate marker of disability. Information was obtained using a patient questionnaire on patient demographics, OCP use, pregnancy history, AS duration, medication use, and hip replacement. RESULTS There were 571 women with AS who participated in our study, consisting of 448 OCP ever-users and 123 non-OCP users. The mean age of OCP users was 42.7 yrs (± 11.5) and of non-OCP users, 48.4 yrs (± 12.1). No difference was noted in the age at initial onset of back pain. However, OCP users were significantly younger at the time of diagnosis of AS (36.5 yrs vs 39.1 yrs, p = 0.02). There were no significant differences between the 2 groups in tumor necrosis factor inhibitor or opioid use, BASFI scores, pregnancy complications, or hip surgery. CONCLUSION The use of exogenous estrogens in the form of OCP is not associated with a measurable effect on initiation or severity of AS. Biologic and social factors may contribute to earlier diagnosis of AS in OCP users. This is the largest study to date investigating the potential effect of exogenous estrogens in women with AS.
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Affiliation(s)
- Dharini Mahendira
- From the Division of Rheumatology, University of Toronto, St. Michael's Hospital (SMH), and the Division of Rheumatology, University of Toronto, Toronto Western Hospital (TWH), Toronto, Ontario, Canada; the Division of Rheumatology, Al Ain Hospital, United Arab Emirates; and the Spondylitis Association of America (SAA), Van Nuys, California, USA.D. Mahendira, MD, MSc, FRCPC, SMH; A. Thavaneswaran, MMath, BSc; A. Carty, BPH; N. Haroon, MD, PhD, DM; A. Anton, BSc; L. Passalent, BScPT, MHSc, TWH; K.A. Alnaqbi, MD, MSc, FRCPC, TWH, and Division of Rheumatology, Al Ain Hospital; L. Savage, MS; E. Aslanyan, BA, SAA; R.D. Inman, MD, FRCPC, TWH.
| | - Arane Thavaneswaran
- From the Division of Rheumatology, University of Toronto, St. Michael's Hospital (SMH), and the Division of Rheumatology, University of Toronto, Toronto Western Hospital (TWH), Toronto, Ontario, Canada; the Division of Rheumatology, Al Ain Hospital, United Arab Emirates; and the Spondylitis Association of America (SAA), Van Nuys, California, USA.D. Mahendira, MD, MSc, FRCPC, SMH; A. Thavaneswaran, MMath, BSc; A. Carty, BPH; N. Haroon, MD, PhD, DM; A. Anton, BSc; L. Passalent, BScPT, MHSc, TWH; K.A. Alnaqbi, MD, MSc, FRCPC, TWH, and Division of Rheumatology, Al Ain Hospital; L. Savage, MS; E. Aslanyan, BA, SAA; R.D. Inman, MD, FRCPC, TWH
| | - Adele Carty
- From the Division of Rheumatology, University of Toronto, St. Michael's Hospital (SMH), and the Division of Rheumatology, University of Toronto, Toronto Western Hospital (TWH), Toronto, Ontario, Canada; the Division of Rheumatology, Al Ain Hospital, United Arab Emirates; and the Spondylitis Association of America (SAA), Van Nuys, California, USA.D. Mahendira, MD, MSc, FRCPC, SMH; A. Thavaneswaran, MMath, BSc; A. Carty, BPH; N. Haroon, MD, PhD, DM; A. Anton, BSc; L. Passalent, BScPT, MHSc, TWH; K.A. Alnaqbi, MD, MSc, FRCPC, TWH, and Division of Rheumatology, Al Ain Hospital; L. Savage, MS; E. Aslanyan, BA, SAA; R.D. Inman, MD, FRCPC, TWH
| | - Nigil Haroon
- From the Division of Rheumatology, University of Toronto, St. Michael's Hospital (SMH), and the Division of Rheumatology, University of Toronto, Toronto Western Hospital (TWH), Toronto, Ontario, Canada; the Division of Rheumatology, Al Ain Hospital, United Arab Emirates; and the Spondylitis Association of America (SAA), Van Nuys, California, USA.D. Mahendira, MD, MSc, FRCPC, SMH; A. Thavaneswaran, MMath, BSc; A. Carty, BPH; N. Haroon, MD, PhD, DM; A. Anton, BSc; L. Passalent, BScPT, MHSc, TWH; K.A. Alnaqbi, MD, MSc, FRCPC, TWH, and Division of Rheumatology, Al Ain Hospital; L. Savage, MS; E. Aslanyan, BA, SAA; R.D. Inman, MD, FRCPC, TWH
| | - Ammepa Anton
- From the Division of Rheumatology, University of Toronto, St. Michael's Hospital (SMH), and the Division of Rheumatology, University of Toronto, Toronto Western Hospital (TWH), Toronto, Ontario, Canada; the Division of Rheumatology, Al Ain Hospital, United Arab Emirates; and the Spondylitis Association of America (SAA), Van Nuys, California, USA.D. Mahendira, MD, MSc, FRCPC, SMH; A. Thavaneswaran, MMath, BSc; A. Carty, BPH; N. Haroon, MD, PhD, DM; A. Anton, BSc; L. Passalent, BScPT, MHSc, TWH; K.A. Alnaqbi, MD, MSc, FRCPC, TWH, and Division of Rheumatology, Al Ain Hospital; L. Savage, MS; E. Aslanyan, BA, SAA; R.D. Inman, MD, FRCPC, TWH
| | - Laura Passalent
- From the Division of Rheumatology, University of Toronto, St. Michael's Hospital (SMH), and the Division of Rheumatology, University of Toronto, Toronto Western Hospital (TWH), Toronto, Ontario, Canada; the Division of Rheumatology, Al Ain Hospital, United Arab Emirates; and the Spondylitis Association of America (SAA), Van Nuys, California, USA.D. Mahendira, MD, MSc, FRCPC, SMH; A. Thavaneswaran, MMath, BSc; A. Carty, BPH; N. Haroon, MD, PhD, DM; A. Anton, BSc; L. Passalent, BScPT, MHSc, TWH; K.A. Alnaqbi, MD, MSc, FRCPC, TWH, and Division of Rheumatology, Al Ain Hospital; L. Savage, MS; E. Aslanyan, BA, SAA; R.D. Inman, MD, FRCPC, TWH
| | - Khalid A Alnaqbi
- From the Division of Rheumatology, University of Toronto, St. Michael's Hospital (SMH), and the Division of Rheumatology, University of Toronto, Toronto Western Hospital (TWH), Toronto, Ontario, Canada; the Division of Rheumatology, Al Ain Hospital, United Arab Emirates; and the Spondylitis Association of America (SAA), Van Nuys, California, USA.D. Mahendira, MD, MSc, FRCPC, SMH; A. Thavaneswaran, MMath, BSc; A. Carty, BPH; N. Haroon, MD, PhD, DM; A. Anton, BSc; L. Passalent, BScPT, MHSc, TWH; K.A. Alnaqbi, MD, MSc, FRCPC, TWH, and Division of Rheumatology, Al Ain Hospital; L. Savage, MS; E. Aslanyan, BA, SAA; R.D. Inman, MD, FRCPC, TWH
| | - Laurie Savage
- From the Division of Rheumatology, University of Toronto, St. Michael's Hospital (SMH), and the Division of Rheumatology, University of Toronto, Toronto Western Hospital (TWH), Toronto, Ontario, Canada; the Division of Rheumatology, Al Ain Hospital, United Arab Emirates; and the Spondylitis Association of America (SAA), Van Nuys, California, USA.D. Mahendira, MD, MSc, FRCPC, SMH; A. Thavaneswaran, MMath, BSc; A. Carty, BPH; N. Haroon, MD, PhD, DM; A. Anton, BSc; L. Passalent, BScPT, MHSc, TWH; K.A. Alnaqbi, MD, MSc, FRCPC, TWH, and Division of Rheumatology, Al Ain Hospital; L. Savage, MS; E. Aslanyan, BA, SAA; R.D. Inman, MD, FRCPC, TWH
| | - Elin Aslanyan
- From the Division of Rheumatology, University of Toronto, St. Michael's Hospital (SMH), and the Division of Rheumatology, University of Toronto, Toronto Western Hospital (TWH), Toronto, Ontario, Canada; the Division of Rheumatology, Al Ain Hospital, United Arab Emirates; and the Spondylitis Association of America (SAA), Van Nuys, California, USA.D. Mahendira, MD, MSc, FRCPC, SMH; A. Thavaneswaran, MMath, BSc; A. Carty, BPH; N. Haroon, MD, PhD, DM; A. Anton, BSc; L. Passalent, BScPT, MHSc, TWH; K.A. Alnaqbi, MD, MSc, FRCPC, TWH, and Division of Rheumatology, Al Ain Hospital; L. Savage, MS; E. Aslanyan, BA, SAA; R.D. Inman, MD, FRCPC, TWH
| | - Robert D Inman
- From the Division of Rheumatology, University of Toronto, St. Michael's Hospital (SMH), and the Division of Rheumatology, University of Toronto, Toronto Western Hospital (TWH), Toronto, Ontario, Canada; the Division of Rheumatology, Al Ain Hospital, United Arab Emirates; and the Spondylitis Association of America (SAA), Van Nuys, California, USA.D. Mahendira, MD, MSc, FRCPC, SMH; A. Thavaneswaran, MMath, BSc; A. Carty, BPH; N. Haroon, MD, PhD, DM; A. Anton, BSc; L. Passalent, BScPT, MHSc, TWH; K.A. Alnaqbi, MD, MSc, FRCPC, TWH, and Division of Rheumatology, Al Ain Hospital; L. Savage, MS; E. Aslanyan, BA, SAA; R.D. Inman, MD, FRCPC, TWH
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