Endometriosis and Systemic Lupus Erythematosus

The Hidden Connection Between Endometriosis and Systemic Lupus Erythematosus

Based on possible shared characteristics and pathogenesis the interconnectedness of various ailments becomes a focal point of research. Such is the relationship between endometriosis and lupus, two seemingly unrelated conditions that share intriguing parallels. This article aims to shed light on the increased risk of being diagnosed with endometriosis in patients suffering from Systemic Lupus Erythematosus or SLE.  The purpose of unraveling connections is that this may lead to treatment discoveries. 

Understanding Endometriosis

Endometriosis is a multifaceted disease that primarily affects women in their reproductive years. It is characterized by the abnormal growth of endometrial-like tissue outside the uterus, leading to chronic pelvic pain, and potential infertility.

The pathophysiology of endometriosis involves a systemic inflammatory response, influenced by female sex hormones that may subtly affect the maintenance of immunity or the development of autoimmune diseases.

Getting to Know Systemic Lupus Erythematosus (SLE)

SLE is a chronic, autoimmune disease that can affect various parts of the body, including the skin, joints, kidneys, heart, and lungs. It involves the immune system attacking the body’s own tissues, leading to inflammation and damage. Women, especially of childbearing age, are more frequently diagnosed with SLE than men. Other factors such as ethnicity, age of onset, and socioeconomic class significantly influence SLE incidence, with notable geographic differences observed. 

Endometriosis and SLE: The Intriguing Association

Epidemiological studies suggest a solid link between endometriosis and female-dominant autoimmune diseases. However, not all studies support a significant association between endometriosis and SLE. The potential for spurious associations due to small study sizes and suboptimal control selection is high.

Unraveling the Connection: A Comprehensive Study

Given these inconsistencies, and accepting that the findings may not be applicable to all geo-ethnic populations, a large nationwide retrospective cohort study was conducted to assess the risk of endometriosis in women diagnosed with SLE. The study analyzed data from the Taiwan Longitudinal Health Insurance Research Database 2000 (n = 958,349) over a 13-year follow-up period (2000–2013).

Study Design and Population

The study adopted a retrospective cohort design with primary data sourced from the Taiwan National Health Insurance Research Database (NHIRD). The study cohort included women diagnosed with SLE between 1997 and 2013, and the index date was defined as the first diagnosis of SLE.

Assessed Outcome

The primary outcome was defined as the diagnosis of endometriosis. Given the lack of non-invasive diagnostic tools for endometriosis, the disease’s diagnosis was derived from clinical evidence or surgical intervention. Every effort was made to optimize parameters of non-surgical diagnosis of endo but surgical validation was lacking in a large number of subjects, representing a significant study weakness. 

Results and Implications

The study, within stated limitations,  found a statistically significant association between SLE and endometriosis, after controlling for age.

Conclusion: A Call for Further Research

The risk of endometriosis was found to be significantly higher in SLE patients compared to the general population in this study. This adds substantially to the overall body of evidence supporting an association.  However, more research is needed to fully understand this association and to determine if it can be generalized across different geo-ethnic populations.  Clearly, more basic science research is also critically needed to support epidemiologic associations. 



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