I know I just posted but I just recalled another extremely interesting thing I learned.
I worked as a clinical researcher for the CU School of Medicine in the Division of Rheumatology. As many people know, women get Rheumatoid Arthritis (and autoimmune diseases) more than men, so one of the research studies in the division was looking at women specifically. The studies generally college self-reported information on diet, health history, family history, and other general data points. On top of the paperwork, we'd collect blood (to test for antibodies), sputum (also to check for antibodies...long story, but ~50% of RA patients also have lung disease so it's almost standard to always consider the lungs as a factor), vaginal + cervical fluids, and sometimes stool (to also test for antibodies and the bacteria).
Some of you may already know, but most of the people who develop RA (and other autoimmunity) are usually pretty young. Most of the people in our studies who had RA were often young women. The PI of this study essentially came to the conclusion that IUDs played a significant role in the development of RA!
This paper (https://www.openaccessjournals.com/articles/rheumatoid-arthritis-activity-and-severity-in-relation-to-commonly-used-contraceptive-methods-in-a-cohort-of-egyptian-fe.pdf) supports your PI's conclusion and theorizes that the IUD in the uterus is seen as a foreign body by the patient's immune system, causing an upregulated level of immune activity that could eventually turn on the body to cause an autoimmune reaction. Only about 7 percent of US women use IUDs, so this can't be causing every case of young-onset RA but it definitely warrants further study.
ReplyDeleteThis title, "beware of IUDs," inflamed every sense in my educated female body and has motivated me to make my own future post on IUDs. First, thank you so much for sharing this research experience. As this is the first time I've heard of such a strong association, I have many questions to the methodology and rigor of this study. As Steven mentioned and the study cited by Ariana, the study population was pulled from female patients ALREADY diagnosed with RA. Therefore, claims on IUDs direct effect on the etiology of RA seems relatively weak.
ReplyDeleteReading the paper that Ariana posted, the study population was first based on a woman cohort from Egypt, which signals to us that we need to keep in mind the differing environmental and epigenetic effects. Secondly, the study spends time explaining that estrogen enhances humoral immunity which could align with the body's upregulated immune responses that trigger RA. The paper also mentioned that progesterone is a natural immune suppressor and the levonorgestrel-releasing intrauterine system (LNG-IUD) works by releasing a synthetic form of progesterone which should, according to the study, counter-act an immune response that leads to RA. This contradiction in the study’s explanation of immune response mechanisms gives me pause. Among other things, I would like to see this as a longitudinal study on women in the United States with a larger and more significant study population. The strength of this association could be elucidated by following more women on IUDs who DO NOT ALREADY HAVE RA. The study also mentioned how first-degree female relatives of known RA patients expressed an increased risk in ACPA positivity – which indicants a strong genetic component that could be exacerbated by an IUD’s mechanisms but NOT likely causal.
I have issues with this study and the phrasing of their conclusions. I also thought their Table 3., which showed a 37.8% onset of RA from persons using combined oral contraception was as significant as the reported 48% of IUD users (who previously have never used IUD) and developed RA. Furthermore Table 4 showed a NON-SIGNIFICANT difference of measured RF titer in persons you had and had not used IUDs prior to RA onset.