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Postmenopausal Hormone Therapy and Systemic Lupus Erythematosus
- Jean-Charles Piette, MD;
- Le Thi Huong Du, MD; and
- Thomas Papo, MD
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•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
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TO THE EDITOR:
Sanchez-Guerrero and colleagues [1] reported that postmenopausal estrogen replacement therapy increases the risk for developing systemic lupus erythematosus. Some unmentioned confounding factors related to the nurses' medical histories should be discussed.
The risk might have been underestimated because a history of thrombosis could have discouraged physicians from prescribing estrogen replacement therapy. Some of these thromboses may have been related to an unrecognized antiphospholipid syndrome, which sometimes precedes full-blown systemic lupus erythematosus [2].
However, the risk may have been overestimated because of the possible inclusion of nurses with other autoimmune but nonrheumatic disorders for which estrogen replacement therapy is favored. Such disorders include “idiopathic” thrombocytopenia requiring steroids and Graves disease; both increase the risk for osteoporosis. In addition, no mention was made of premature ovarian failure, a condition for which hormone replacement therapy is commonly used. This condition sometimes results from autoimmune reactions directed against the ovaries. Antiovarian antibodies are frequently found in the sera of patients with systemic lupus erythematosus [3], and 10% of women with premature ovarian failure have antibodies to native DNA [4]. Moreover, some case reports have described an association between premature ovarian failure and systemic lupus erythematosus [5].
Because of these factors, systemic lupus erythematosus was more likely to occur in patients with previous thrombocytopenia and probably in those with organ-specific disorders such as Graves disease or premature ovarian failure. Although autoimmune premature ovarian failure is rare, so was the occurrence of systemic lupus erythematosus in the study by Sanchez-Guerrero and colleagues, even when only three American College of Rheumatology criteria were used to define the disease.
To exclude assessable potential biases, data should be given on women aged 40 years or older at menopause who never received steroids and had no previous autoimmune disorders.
Jean-Charles Piette, MD
Le Thi Huong Du, MD
Thomas Papo, MD
Groupe Hospitalier Pitie-Salpetriere; 75013 Paris, France
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
