Risk of systemic lupus erythematosus in patients with endometriosis: A nationwide population-based cohort study

Ya-Hui Lin, Ya‐Hui Lin, Lin YH, Yu-Cih Yang, Yang YC, Yu‐Cih Yang, Shih‐Fen Chen, Shih-Fen Chen, Chen SF, Hsu CY, Chung-Y Hsu, Chung Y. Hsu, Yu‐Chih Shen
Archives of gynecology and obstetrics · 2020 · vol. 302(5) , pp. 1197–1203 · doi:10.1007/s00404-020-05726-9 · PMID:32767040 · W3048076044
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This study found that patients with endometriosis had an increased risk of systemic lupus erythematosus (SLE), which could be reduced by hormonal treatment.

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Abstract

PurposeThe etiology of endometriosis is mostly under-explored, but abnormalities in the immune system leading to an autoimmune reaction have been suggested. The systemic lupus erythematosus (SLE) is one of the most common autoimmune diseases. The purpose of this study was to investigate the risk of SLE in patients with endometriosis.MethodsA total of 17,779 patients with endometriosis and 17,779 controls (without endometriosis) matched by age, index year, and Charlson Comorbidity Index (CCI) score were enrolled between 2000 and 2012. Patients were then followed until the end of 2013 using Taiwan's National Health Insurance Research Database, at which time participants who developed SLE were identified. Cox regression analysis was used to calculate the hazard ratio (HR) with a 95% confidence interval (CI) of SLE incidence rate between patients with endometriosis and unaffected controls.ResultsAfter adjusting for age, CCI score, and different treatment options, patients with endometriosis were at increased risk of SLE compared to unaffected controls (0.85 versus 0.57 per 1000 person-years, HR 1.86, 95% CI 1.36-2.53). Also, higher baseline CCI scores (CCI score 1-2 and  ≥ 3 vs. 0-HR 2.33-4.98) were at increased risk of SLE. During follow-up, hormonal treatment for endometriosis could reduce the risk of SLE (short-term and long-term vs. non-use HR 0.48-0.62), while surgical treatment appeared to have a limited impact on the risk of SLE.ConclusionPatients with endometriosis were at increased risk of SLE, and adequate hormonal treatment could reduce the risk of SLE, providing a reference for developing prevention interventions.
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Abstract

Purpose The etiology of endometriosis is mostly under-explored, but abnormalities in the immune system leading to an autoimmune reaction have been suggested. The systemic lupus erythematosus (SLE) is one of the most common autoimmune diseases. The purpose of this study was to investigate the risk of SLE in patients with endometriosis.

Methods

A total of 17,779 patients with endometriosis and 17,779 controls (without endometriosis) matched by age, index year, and Charlson Comorbidity Index (CCI) score were enrolled between 2000 and 2012. Patients were then followed until the end of 2013 using Taiwan’s National Health Insurance Research Database, at which time participants who developed SLE were identified. Cox regression analysis was used to calculate the hazard ratio (HR) with a 95% confidence interval (CI) of SLE incidence rate between patients with endometriosis and unaffected controls.

Results

After adjusting for age, CCI score, and different treatment options, patients with endometriosis were at increased risk of SLE compared to unaffected controls (0.85 versus 0.57 per 1000 person-years, HR 1.86, 95% CI 1.36–2.53). Also, higher baseline CCI scores (CCI score 1–2 and ≥ 3 vs. 0—HR 2.33–4.98) were at increased risk of SLE. During follow-up, hormonal treatment for endometriosis could reduce the risk of SLE (short-term and long-term vs. non-use HR 0.48–0.62), while surgical treatment appeared to have a limited impact on the risk of SLE.

Conclusion

Patients with endometriosis were at increased risk of SLE, and adequate hormonal treatment could reduce the risk of SLE, providing a reference for developing prevention interventions. Similar content being viewed by others

References

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Acknowledgements

The authors thank Shinn-Zong Lin for cross-hospital integration. Funding This study is supported in part by the Taiwan Ministry of Health and Welfare Clinical Trial Center (MOHW109-TDU-B-212-114004); MOST Clinical Trial Consortium for Stroke, Taiwan (MOST 108-2321-B-039-003); Tseng-Lien Lin Foundation, Taichung, Taiwan. The funding source has no further role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication. Author information Authors and Affiliations Contributions YHL and SFC managed the literature searches and wrote the introduction of the manuscript. YCY and CYH did all the analyses and wrote the method and results of the manuscript. YCS conceived the study and wrote the discussion of the manuscript. All authors have approved the final manuscript. Corresponding author Ethics declarations Conflict of interest The authors declare no conflict of interest. Ethical approval The Institutional Review Board of China Medical University approved this study (CMUH104-REC2-115). All research methods were carried out following guidelines and regulations. Informed consent Since the NHIRD only contains anonymized secondary data, the need for informed consent from individual subjects has been lifted. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions About this article Cite this article Lin, YH., Yang, YC., Chen, SF. et al. Risk of systemic lupus erythematosus in patients with endometriosis: A nationwide population-based cohort study. Arch Gynecol Obstet 302, 1197–1203 (2020). https://doi.org/10.1007/s00404-020-05726-9 Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00404-020-05726-9

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endometriosis

MeSH descriptors

Endometriosis Endometriosis Lupus Erythematosus, Systemic Lupus Erythematosus, Systemic Lupus Erythematosus, Systemic Adult Case-Control Studies Cohort Studies Female Humans Incidence Middle Aged Risk Factors Taiwan Taiwan

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