Endometriosis and the risks of systemic lupus erythematosus and rheumatoid arthritis in the Nurses' Health Study II
Open accessAbstract
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.
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Women with endometriosis are more likely to be diagnosed with inflammatory bowel diseases, allergic manifestations, and autoimmune diseases.
“An increased risk of inflammatory bowel diseases (Chron’s disease, ulcerative colitis) [146] allergic manifestations [sinus allergic rhinitis, and food allergy) [147], autoimmune diseases (systemic lupus erythematosus, rheumatoid arthritis, Sjogren’s syndrome, multiple sclerosis, fibromyalgia) are more likely to be diagnosed in women with endometriosis”
From Hormonal treatments for endometriosis: The endocrine background (2022) · cites this paper as [149]
The Results report that women with laparoscopically confirmed endometriosis had increased subsequent diagnoses of systemic lupus erythematosus and rheumatoid arthritis, although adjustment for hysterectomy or oophorectomy made the associations nonsignificant. The Introduction mentions multiple sclerosis only as suggested comorbidity in case reports; the paper does not establish increased diagnoses of Sjögren’s syndrome or fibromyalgia. Inflammatory bowel diseases and allergic manifestations have separate citations in the citing sentence, so they are not attributed to this source here. (LLM, conf=0.88)
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- Authors
- Harris, H. R., Costenbader, K. H., Mu, F., Kvaskoff, M., Malspeis, S., Karlson, E. W., & Missmer, S. A.
- Affiliations
- Brigham and Women's Hospital (US)
- Harvard University (US)
- Université Paris-Sud (FR)
- Corresponding author
- Harris, Holly R
- ORCID
- Venue
- Annals of the Rheumatic Diseases
- Publisher
- Elsevier BV
- Published
- 2016-07
- Volume
- 75
- Issue
- 7
- Pages
- 1279-1284
- ISSN
- 0003-4967 (ISSN-L)
- PMC
- PMC4740245
- OpenAlex
- W1937039726
- Cited by
- 112
- References
- 51
- Citations by year
- 2026: 6 · 2025: 15 · 2024: 17 · 2023: 6 · 2022: 15 · 2021: 10 · 2020: 12 · 2019: 8 · 2018: 8 · 2017: 6 · 2016: 9
- FWCI
- 13.73
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- Locations
- Annals of the Rheumatic Diseases (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- National Cancer Institute (UM1CA176726)
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01AR049880, P30AR070253)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD057210, R01HD052473)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Rheumatology › Systemic Lupus Erythematosus Research
- Life Sciences › Immunology and Microbiology › Immunology › Reproductive System and Pregnancy
- Keywords
- endometriosis, systemic lupus erythematosus, rheumatoid arthritis, autoimmune disease susceptibility, hysterectomy, oophorectomy, immune dysfunction, temporal association, women's health
- MeSH terms
- Adult, Arthritis, Rheumatoid, Endometriosis, Female, Follow-Up Studies, Humans, Lupus Erythematosus, Systemic, Nurses, Prospective Studies, Risk Factors, Proportional Hazards Models
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