Background Androgens are generally immunosuppressive, and men with untreated hypogonadism are at increased risk for autoimmune conditions. To date, there has been no evidence linking androgen deprivation therapy (ADT) to autoimmune diseases, including rheumatoid arthritis (RA). We investigated the association between ADT and RA in patients with prostate cancer. Patients and methods We identified 105 303 men age 66 years or older who were diagnosed with stages I-III prostate cancer from 1992 through 2006 using the Surveillance, Epidemiology, and End Results-Medicare linked database, excluding patients with a history of RA. χ2 test was used to compare 5-year Kaplan-Meier rates of RA diagnoses. Competing risk Cox regression using inverse probability of treatment weighting was utilized to examine the association between pharmacologic ADT and diagnosis of RA. Results The 43% of patients (N = 44 785) who received ADT experienced a higher 5-year rate of RA diagnoses compared with men who did not (5.4% versus 4.4%, P < 0.001). Receipt of any ADT was associated with a 23% increased risk of being diagnosed with RA (hazard ratio 1.23, 95% confidence interval 1.09-1.40, P = 0.001). The risk of being diagnosed with RA increased with a longer duration of ADT, from 19% with 1-6 months and 29% with 7-12 months to 33% with ≥13 months (Ptrend < 0.001). Conclusions Consistent with the immunosuppressive properties of androgens, we demonstrated for the first time that ADT was associated with an elevated risk of being diagnosed with RA in this large cohort of elderly men with prostate cancer. The risk was higher with a longer duration of ADT. Linking ADT to an increased risk of being diagnosed with an autoimmune condition adds to mounting evidence of the adverse effects of ADT that should prompt physicians to thoughtfully weigh its risks and benefits.

中文翻译：

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局部前列腺癌患者的雄激素剥夺治疗和类风湿关节炎的风险。

背景雄激素通常具有免疫抑制作用，患有未经治疗的性腺功能减退症的男性罹患自身免疫疾病的风险增加。迄今为止，尚无证据将雄激素剥夺疗法（ADT）与包括类风湿性关节炎（RA）在内的自身免疫性疾病联系起来。我们调查了前列腺癌患者中ADT和RA之间的关联。患者和方法我们使用监测，流行病学和最终结果-医疗保险相关数据库，从1992年至2006年，确定了105303名66岁或以上的男性，诊断为I-III期前列腺癌，但不包括具有RA史的患者。χ2检验用于比较RA诊断的5年Kaplan-Meier率。使用治疗加权比值的逆概率进行竞争风险Cox回归，以研究药理学ADT与RA诊断之间的关联。结果与未接受ADT的男性相比，接受ADT的43％的患者（N = 44785）与未接受ADT的男性相比有更高的5年RA诊断率（5.4％对4.4％，P <0.001）。接受任何ADT都会使被诊断为RA的风险增加23％（危险比1.23，95％置信区间1.09-1.40，P = 0.001）。随着ADT持续时间的延长，被诊断为RA的风险从1-6个月的19％和7-12个月的29％增加到≥13个月的33％（Ptrend <0.001）。结论与雄激素的免疫抑制特性一致，我们首次证明，在这一庞大的老年前列腺癌患者队列中，ADT与确诊为RA的风险增加有关。ADT持续时间越长，风险越高。将ADT与被诊断为自身免疫性疾病的风险增加联系起来，增加了越来越多的证据表明ADT的不良作用，应促使医师们仔细考虑其风险和益处。