Does Endo mean that at some point you will have more health problems? Researchers have long suspected a link between endometriosis and a higher risk of developing other autoimmune diseases such as multiple sclerosis, lupus, and inflammatory bowel disease. A new 14-year-old study from Taiwan, published in the December 2020 issue of Rheumatology, is helping solidify the hypothesis of a link between endometriosis – a condition in which endometrial-like tissue outside the uterus on other organs such as the ovaries, fallopian tubes etc. grows. The intestines and outer walls of the uterus – and one of those autoimmune diseases, rheumatoid arthritis (RA), a chronic inflammatory disease of the joints.
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Women with endometriosis had an increased rate of RA, other autoimmune diseases
The researchers used data from the Longitudinal Health Insurance Database 2000 from Taiwan, which included a total of 14,463 women. The mean age of the endometriosis group was 38.7 years; 38.9 for the group without the disease. They were all rated for age, comorbidities, corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), and hormonal drugs. Over time, the group with endometriosis had a significantly higher risk of developing RA than women without endometriosis. If they looked at patients with endometriosis and another autoimmune disease, they were also at a higher risk of developing RA.
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The data link between Endo and RA is confirmed by other studies
“This paper presents a well-designed, large-scale study examining the relationship between endometriosis and RA risk and has generated some very interesting data that needs further investigation. The results are consistent with those reported in other large-scale cohort studies such as the Nurses’ Health Study II in the US, and show a slightly increased risk of RA in women diagnosed with endometriosis, ”says Krina Zondervan DPhil, department head and Professor of Reproductive and Gnomic Epidemiology at Oxford University in England. Dr. Zondervan was not part of this study but did investigate the subject.
She adds that in the Nurses’ Health Study II, the effect did not become significant when considering a history of a hysterectomy (removal of the uterus) or an oophorectomy (removal of the ovaries). “This new study does not examine the potential impact of surgery on RA risk. Also, the prevalence of RA is higher in women, suggesting an estrogen association, while endometriosis is an estrogen-dependent disease. “
What could be driving the Endo-RA connection?
“We don’t know the exact mechanism. We hypothesized that endometriosis can cause chronic information and trigger immunity dysregulation that leads to RA. The other reason is that autoimmunity can be the underlying disease of endometriosis, ”says study author James Cheng-Chung Wei, MD, PhD, professor at the Institute of Medicine at Chung Shan Medical University in Taiwan.
When endometriosis lesions develop, they produce an increased inflammation profile and an increased immune response. The inflammation is not just local to these lesions; It is systemic, meaning that it exists throughout the patient’s body. “The hypothesis is that the inflammation increases the immune system, which in turn attacks other target tissues such as the joints and intestines. Inflammation is the precursor to many different disease pathologies. That is why this data is important; It shows how far an overactive immune system can spread, ”explains Dr. Andrea Braundmeier-Fleming, assistant professor in the Department of Medical Microbiology, Immunology, and Cell Biology at the Medical School of Southern Illinois University in Springfield, who was not involved in the study.
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Doctors need to consider the link between the diseases
Clinicians, aware of the power of the immune system, would do a lot more in treating women with endometriosis, continues Dr. Braundmeier-Fleming continued: “However, many clinicians still treat endometriosis as a simple endocrine disorder. I’m just talking about hormonal imbalance; They don’t look to see what effects it has on the immune system. With this type of research article, I hope clinicians pay more attention to how the immune system is involved in causing the pain and infertility that women with endometriosis have. “
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If you have either disease, use this information for an earlier diagnosis
“It is good for women with endometriosis to be aware of RA and its symptoms and vice versa. Both diseases require early diagnosis and treatment, ”says Zondervan, who is also co-director of the Endometriosis Care Center at Oxford University. Early diagnosis and treatment of both diseases leads to better results in the long term, especially with endometriosis, where the average woman waits 4 to 11 years from symptoms to diagnosis.
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In the future, RA drugs could be used to treat endometriosis
The concept that endometriosis is an autoimmune disease is fairly new, says Braundmeier-Fleming, adding that clinical trials are currently being investigated to see if the use of RA drugs for endometriosis helps. “I really hope some of these rheumatologists are biological [DMARDs] can be used for endometriosis patients. We have seen it anecdotally in RA patients who have been prescribed medication who then find that their endometriosis improves significantly as well. What I would love is this [using RA drugs off-label for endometriosis] is becoming a first generation approach rather than waiting for a secondary immune disease to develop, ”she says.
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