Gynaecological history and details of development of osteoarthritis and rheumatoid arthritis in middle aged women Median Median age Median time from Median age at at onset of Median age No (%/O) who Median age at hysterectomy No in age No (% menopause symptoms at referral had had hysterectomy to referral group (years) nulliparous (years) (years) (years) hysterectomy (years) (years) Osteoarthritis group 292 58 52 (18) 49-5 49 53 82 (28)* 42 6 years Rheumatoid arthritis group 270 59 71(27) 49 5 48 50 39(14)* 45 4 years Electoral register population 243 50 33 (14) 50 37 (15) 43 Local general practice population 346 54 71 (29) 50 38 (11) 41*Sixty three (77%) and 25 (64%) hysterectomies were carried out at least one year before referral to hospital in the osteoarthritis and rheumatoid arthritis groups respectively.implied that the indications for surgery might be more important than surgery itself.There are several poten- tial biases.Early symptoms in women with osteo- arthritis may have been misinterpreted and resulted in hysterectomy.This is unlikely given the long median delay (six years) between operation and diagnosis and that those with spinal osteoarthritis did not have the greatest rate of hysterectomy.The difference in rate of hysterectomy between the women with osteoarthritis and those with rheumatoid arthritis may have been due to fewer gynaecological abnormalities occurring in those with rheumatoid arthritis.Previous studies found no difference between women with rheumatoid arthritis and controls,2 and the rates of hysterectomy in women with rheumatoid arthritis were similar to those in our population controls.By contrast, a link between hysterectomy and predisposition to osteoarthritis is biologically plausible.Dysfunctional uterine bleeding and fibroids, the main reasons for hysterectomy in our study, have both been attributed to an excess of oestrogens.Oestrogens have also been found to affect adversely several different animal models of
The endocrinology of ectopic pregnancy was studied in order to investigate the origin of the discordance in the circulating amounts of human chorionic gonadotrophin (HCG) and those of oestradiol and progesterone. Serial maternal blood samples were obtained at 4-9 weeks gestation from 93 patients who became pregnant following in-vitro fertilization and embryo transfer including 10 ectopic, 21 anembryonic and 62 normal singleton pregnancies. The samples were analysed for HCG, Schwangerschaft protein-1 (SP-1), pregnancy-associated plasma protein-A (PAPP-A), progesterone and oestradiol. In ectopic pregnancies, concentrations of all substances analysed were significantly reduced compared to singleton pregnancies from 5 weeks gestation (P < 0.05-0.001) but they were not significantly different from those of anembryonic pregnancies. In ectopic pregnancies, associations were found between the concentration of both HCG and SP-1 and those of progesterone and oestradiol. No associations were found between PAPP-A and any other substances analysed. This may be due to insensitivity of the PAPP-A assay; alternatively PAPP-A concentrations may be differentially reduced in ectopic pregnancy. These findings suggest that progesterone and oestradiol are derived from the corpus luteum in early ectopic pregnancy but that the corpus luteum fails rapidly and the dominant source of both hormones becomes the trophoblast as early as 5 weeks.
The endocrine function of the corpus luteum and placenta and the inter-relationships between ovarian steroids and the placental proteins in pregnancies achieved following ovarian stimulation, in-vitro fertilization and embryo transfer (IVF-ET) have been investigated. The serum concentrations of human chorionic gonadotrophin (HCG), Schwangerschaft protein-1 (SP-1), pregnancy-associated plasma protein A (PAPP-A), progesterone and oestradiol were measured at weekly intervals between the 4th (ET plus 2 weeks) and 14th week of gestation in 86 pregnancies. The mean concentrations of the placental proteins and oestradiol were significantly higher in twin than in singleton pregnancies from as early as 5 weeks gestation, but the mean concentrations of progesterone were significantly higher only at the end of the first trimester. Ranking, as demonstrated by the presence of statistically significant correlations between serum levels of each substance analysed in week 13 with those of preceding weeks, was established for progesterone and SP-1 from the 5th week, for oestradiol and PAPP-A from the 7th week and for HCG from the 8th week of gestation. The presence of statistically significant correlations between each substance analysed suggests that the placenta becomes the dominant source of oestradiol from 8 weeks gestation and of progesterone not until 12 weeks gestation, and that the placental synthesis of HCG, SP-1, PAPP-A, oestradiol and progesterone appear to be linked. There were no statistically significant correlations between the serum concentrations of HCG and either progesterone or oestradiol until the production of each had become predominantly placental.
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