Osteoarthritis (OA) is an incurable disease characterized by pain, swelling and stiffness of joints, leading to loss of joint functioning. It is not possible to heal OA except by means of joint replacement surgery. OA treatment for pain relief or joint replacement leads to substantial costs. Finger joints are non-weight bearing and present ideal joints to study a possible association between intake of medication and the risk of developing OA, since pressure on joints by body weight, a major risk factor for OA in knees and in the hip, does not apply.
The drop in levels of female hormones after menopause (1 year after the last menstrual bleeding) was associated with a corresponding peak in onset of hand OA. Replacing these hormones with synthetically manufactured hormones can alleviate the main symptoms of menopause (night sweats, hot flushes, vaginal dryness, and more fragile bones). Animal studies and small studies in humans investigated possible effects of these hormones on OA in different joints and reported conflicting results. Thus, the role of age at menopause, timing of therapy start after menopause, type of therapy used, hormone dose and application route should be explored in additional studies.
We will create an inception cohort of women followed up from the 1st of July the year they turned 45 years onwards. Some of these women will start estrogen replacement therapy and tibolone (further collectively referred to as hormone replacement therapy [HRT]) or raloxifene at some point during their follow-up, while others will not. We will quantify crude incidence rates (IR) of incident hand OA (HOA) in HRT or raloxifene exposed women as well as in unexposed women overall and stratified by age groups. In a matched (1:4) case control analysis, nested in this overall cohort, we will apply multivariable conditional logistic regression analyses to calculate odds ratios (OR) with 95% confidence intervals (CI) of the association between incident HRT or raloxifene use and HOA, stratified by duration of HRT or raloxifene use, by womens age at menopause, by presence or absence of bilateral oophorectomy, by type of therapy used, by estrogen route, by estrogen dosage (daily and cumulative), and by cumulative raloxifene and tibolone dosage. The proposed study is the first to evaluate the association between HRT or raloxifene use and HOA development, taking into account the role of timing of HRT or raloxifene initiation, type and dosage and route of administration of HRT or raloxifene.
Hand osteoarthritis
Susan Jick - Chief Investigator - BCDSP - Boston Collaborative Drug Surveillance Program
Marlene Rauch - Corresponding Applicant - University of Basel
- Collaborator -
Christoph Meier - Collaborator - University of Basel
Daniel Prieto-Alhambra - Collaborator - University of Oxford
Theresa Burkard - Collaborator - University of Basel
Christoph Meier - Collaborator - University of Basel
Julia Spoendlin - Collaborator - University of Basel
Patient Level Index of Multiple Deprivation