Jean-Charles Piette, MD; Le Thi Huong Du, MD; Thomas Papo, MD
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Piette J, Du LTH, Papo T. Postmenopausal Hormone Therapy and Systemic Lupus Erythematosus. Ann Intern Med. 1995;123:961-962. doi: 10.7326/0003-4819-123-12-199512150-00016
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Published: Ann Intern Med. 1995;123(12):961-962.
TO THE EDITOR:
Sanchez-Guerrero and colleagues  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 .
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 , and 10% of women with premature ovarian failure have antibodies to native DNA . Moreover, some case reports have described an association between premature ovarian failure and systemic lupus erythematosus .
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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