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a Department of Rheumatology, St Thomas's
Hospital, London , b Department of Rheumatology, Whipps Cross
Hospital, London
Correspondence to: Dr T D Spector, Twin Research Unit, St Thomas's Hospital, Lambeth Palace Road, London SE1 7EH.
Accepted for publication 15 April 1997
OBJECTIVES
To explore whether hormone
replacement therapy (HRT) has a protective role for osteoarthritis (OA)
of the hand and knee in a cross sectional study of women in the general population.
METHODS1003 women aged 45-64 (mean age 54.2)
from the Chingford Study were asked details of HRT use. Standard
anteroposterior radiographs of hands, knees were taken and scored
according to the methods of Kellgren and Lawrence (grade 2+ positive
for OA), and using individual features of osteophytes and joint space
narrowing. Analysis compared ever use (> 12 months) versus never use,
and current use (> 12 months) versus never use. Only 606 definitely postmenopausal women were included in the analysis. Odds ratios and
95% confidence intervals were calculated using logistic regression for
risk of user versus non-user at each site, adjusted for age, height and
weight, menopausal age and for bone mineral density of the femoral neck.
RESULTSFor current users (n=72) there was a
significant protective effect of HRT for knee OA (defined by Kellgren
and Lawrence grade or osteophytes 0.31 (95% CI 0.11, 0.93), and a
similar but not significant effect for moderate joint space narrowing
of the knee, 0.41 (95% CI 0.05, 3.15) and for distal interphalangeal
OA 0.48 (95% CI 0.17, 1.42). No clear effect was seen for the
carpometacarpal joint, CMC OA 0.94 (95% CI 0.44, 2.03). When analysing
ever users (n=129) the protective effect was reduced. For ex-users of
>12 months (mean duration 40.7 months), there was no overall
protective effect of HRT for OA. Additional adjustment for
hysterectomy, physical activity, social class, and smoking made little
difference to the results.
CONCLUSIONSThese data show an inverse
association of current HRT use and radiological OA of the knee
suggestive of a protective effect. The effect was weaker in the hand
joints. The mechanism of the protection is unclear but has important
implications for aetiopathogenesis.
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