Menopausal hormone therapy may increase risks for lupus, systemic sclerosis
Key takeaways:
- Risks were particularly high in women who received both systemic and local hormone therapies.
- Future studies should explore the relationship between MHT and clinical phenotypes in SLE and SSc.
The odds of developing systemic lupus erythematosus or systemic sclerosis appear to significantly increase with the use of menopausal hormone therapy, according to data published in Rheumatology.
“There are considerable sex imbalances in the immune-mediated diseases systemic lupus erythematosus and systemic sclerosis; women comprise more than 80% of the patient populations,” Karina Patasova, of the Karolinska Institute, in Sweden, and colleagues wrote.
“In addition to the immunomodulatory role of sex hormones, there is also evidence suggesting a link between exogenous estrogens, such as menopausal hormone therapy (MHT), and increased risk of SLE as well as mild to moderate flares in established disease,” they added. “Similar to SLE, strong clinical and immunological differences between men and women have been described in SSc. Given these differences, an influence of sex hormones has been suggested, but only a few studies have directly assessed the impact of sex hormones on SSc pathogenesis.”
To examine the links between MHT and the risks for SLE and SSc, Patasova and colleagues conducted two case-control studies — one for each disease — using nationwide registries in Sweden. Each study matched women aged 40 years and older (SLE n = 943; SSc n = 733) in a 1:10 ratio with control patients from the general Swedish population, and used conditional logistic regression, adjusted for socioeconomic factors, to investigate connections between MHT and the two diseases.
Women with SLE or SSc were included if they had a non-primary care visit with one of those diseases as the main diagnosis from January 2009 through December 2019, as well as an additional visit within 1 year. Exposure to MHT, defined as being dispensed MHT at any time before the first study visit, was assessed using data from Sweden’s Prescribed Drugs Register.
According to the researchers, women who received MHT demonstrated significantly increased risks for both SLE (OR = 1.3; 95% CI, 1.1-1.6) and SSc (OR = 1.4; 95% CI, 1.2-1.7), compared with those never dispensed MHT. Greater odds of developing either disease were observed among women who received both systemic and local MHT medications. Those odds ratios were 1.9 in SLE (95% CI, 1.4-2.7) and 1.8 in SSc (95% CI, 1.2-2.5), compared with never-users.
“Future investigations should explore the relationship between MHT and clinical phenotypes in SLE and SSc,” Patasova and colleagues wrote. “Our findings indicate that MHT use might increase the risk of SLE/SSc. Future research should focus on the validation and functional interpretation of these results.”
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