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2016 ; 75
(7
): 1279-84
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Endometriosis and the risks of systemic lupus erythematosus and rheumatoid
arthritis in the Nurses Health Study II
#MMPMID26238146
Harris HR
; Costenbader KH
; Mu F
; Kvaskoff M
; Malspeis S
; Karlson EW
; Missmer SA
Ann Rheum Dis
2016[Jul]; 75
(7
): 1279-84
PMID26238146
show ga
OBJECTIVES: The aetiologies of endometriosis, systemic lupus erythematosus (SLE)
and rheumatoid arthritis (RA) are all characterised by immune dysfunction. SLE
and RA occur more often in women, and reproductive and hormonal factors have been
shown to be related to increased risk. However, only one previous study has
evaluated the temporal association between endometriosis and SLE or RA. We sought
to investigate the association between laparoscopically confirmed endometriosis
and subsequently diagnosed SLE and RA. METHODS: We analysed data from the Nurses'
Health Study II (n=114?453 women) over a 22-year follow-up period. Multivariable,
time-varying Cox proportional hazards models were used to calculate HRs and 95%
CIs for the association between laparoscopically confirmed endometriosis and
confirmed incident SLE or RA. RESULTS: From 1989 to 2011, 103 incident cases of
SLE and 390 cases of RA were confirmed. Laparoscopically confirmed endometriosis
was significantly associated with subsequent SLE diagnosis (HR=2.03; CI 1.17 to
3.51) and RA diagnosis (HR=1.41; CI 1.05 to 1.89). These associations were robust
to adjustment for SLE or RA risk factors and for potential confounders; however,
adjustment for hysterectomy and oophorectomy attenuated both relations such that
they were no longer significant. No significant differences by infertility status
or age (<45?years) were observed. CONCLUSIONS: Our findings suggest an
association between endometriosis and risk of SLE and RA. It remains to be
understood whether and how endometriosis itself, or hysterectomy or other factors
associated with endometriosis, is related to risk of SLE or RA.