THE PILL, PARITY, AND RHEUMATOID-ARTHRITIS

We report on a case‐control study investigating the relationship of oral contraceptive pill (OCP) use and parity to the development of rheumatoid arthritis (RA). Women with RA were compared with 2 separate control groups, women with osteoarthritis (OA) and women randomly selected from a population‐based electoral register. Nulliparity was found to be a risk factor for the development of RA, with age‐adjusted odds ratios of 1.82 (95% confidence interval [CI] 1.09‐3.03) versus the OA control group and 1.83 (95% CI 1.03–3.06) versus the population control group. Use of OCPs before the age of 35 was negatively associated with RA (odds ratio 0.56, 95% CI 0.29–1.12 versus the OA control group; odds ratio 0.6, 95% CI 0.30–1.17 versus the population control group). Some evidence of a duration‐response effect was seen, although the numbers were small. The 2 variables were also multiplicative, with nulliparous non‐OCP users having a 4‐fold risk of RA compared with parous OCP users. These findings suggest that pregnancy and OCP use have a “protective effect” on the development of RA, although the mechanism remains unclear. Copyright © 1990 American College of Rheumatology