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Vol. 6. Issue 5.
Pages 264-267 (September - October 2010)
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Vol. 6. Issue 5.
Pages 264-267 (September - October 2010)
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Utilization of hyperestrogenic therapies in systemic lupus erythematosus
Utilización de terapias hiperestrogénicas en el lupus eritematoso sistémico
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Jaime Calvo-Alén
Corresponding author
jcalvo@hsll.scsalud.es

Corresponding author.
, Cristina Mata, Elena Aurrecoechea
Sección de Reumatología, Hospital General Sierrallana, IFIMAV, Universidad de Cantabria, Cantabria, Spain
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Abstract

The use of treatments that increase oestrogen levels has usually been deemed risky in lupus patients. Past studies about the utilisation of oral contraceptive drugs and hormone replacement therapy (HRT) have shown contradictory results. More recently, prospective studies about this issue suggest that either oral anticontraceptives or HRT can be used in patients with stable disease without special risk for increments in clinical activity. Neither has an association with the development of arterial or venous thrombosis been observed. However, in this respect, several methodological limitations preclude establishing definitive conclusions.

Regarding the use of assisted reproduction techniques in lupus patients, only retrospective data are available. Overall they indicate that the real risk of disease exacerbation is quite low, the flares being generally mild when these procedures are performed in patients with stable disease.

Keywords:
Systemic lupus erythematosus
Estrogen
Assisted fertilization
Resumen

La utilización de tratamientos que aumenten los niveles estrogénicos ha sido considerada clásicamente de riesgo en pacientes lúpicos. Estudios relativamente antiguos sobre la utilización de anticonceptivos orales y de tratamiento hormonal sustitutivo han proporcionado resultados contradictorios o inconsistentes. Más recientemente, estudios prospectivos sobre esta problemática sugieren que tanto los anticonceptivos como el tratamiento hormonal sustitutivo pueden ser utilizados en pacientes con enfermedad estable sin riesgo de un aumento en la actividad clínica de ésta. Tampoco se ha observado una asociación al desarrollo de complicaciones tromboembólicas arteriales y/o venosas. Aunque, a este respecto, determinaciones y limitaciones metodológicas imposibilitan el establecer valoraciones definitivas sobre esta problemática.

Con respecto a la utilización de técnicas de fertilización asistida en pacientes lúpicas, todos los datos de que se disponen son de tipo retrospectivo. Globalmente considerados, estos estudios indican que el riesgo real de reagudización de la enfermedad es relativamente bajo y que, en general, no son agudizaciones graves, siempre y cuando estas técnicas se realicen en pacientes con enfermedad estable.

Palabras clave:
Lupus eritematoso sistémico
Estrógenos
Fertilización asistida
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References
[1.]
H. Carlsten, A. Tarkowski.
Histocompatibility complex gene products and exposure to oestrogen: Two independent disease accelerating factors in murine lupus.
Scand J Immunol, 38 (1993), pp. 341-347
[2.]
J.R. Roubinian, N. Talal, J.S. Greenspan, J.R. Goodman, P.K. Siiteri.
Effect of castration and sex hormone treatment on survival, anti-nucleic acid antibodies, and glomerulonephritis in NZB/NZW F1 mice.
J Exp Med, 147 (1978), pp. 1568-1583
[3.]
J. Sánchez-Guerrero, E.W. Karlson, M.H. Liang, D.J. Hunter, F.E. Speizer, G.A. Colditz.
Past use of oral contraceptives and the risk of developing systemic lupus erythematosus.
[4.]
J. Sánchez-Guerrero, M.H. Liang, E.W. Karlson, D.J. Hunter, G.A. Colditz.
Postmenopausal estrogen therapy and the risk for developing systemic lupus erythematosus.
Ann Intern Med, 122 (1995), pp. 430-433
[5.]
R.G. Lahita, L. Bradlow, J. Fishman, H.G. Kunkel.
Estrogen metabolism in systemic lupus erythematosus: Patients and family members.
Arthritis Rheum, 25 (1982), pp. 843-846
[6.]
I.N. Bruce, C.A. Laskin.
Sex hormones in systemic lupus erythematosus: a controversy for modern times.
J Rheumatol, 24 (1997), pp. 1461-1463
[7.]
B. Pimstone.
Systemic lupus erythematosus exacerbated by oral contraceptives.
S Afr J Obstet Gynecol, 3 (1966), pp. 62-63
[8.]
T.A. Chapel, R.E. Burns.
Oral contraceptives and exacerbation of lupus erythematosus.
Am J Obstet Gynecol, 110 (1971), pp. 366-369
[9.]
R.L. Travers, G.R. Hughes.
Oral contraceptive therapy and systemic lupus erythematosus.
J Rheumatol, 5 (1978), pp. 448-451
[10.]
M. Garovich, C. Agudelo, E. Pisko.
Oral contraceptives and systemic lupus erythematosus.
Arthritis Rheum, 23 (1980), pp. 1396-1398
[11.]
F. Furukawa, T. Tachibana, S. Imamura, T. Tamura.
Oral contraceptive-induced lupus erythematosus in a Japanese woman.
J Dermatol, 18 (1991), pp. 56-58
[12.]
P. Jungers, M. Dougados, C. Pelissier, F. Kuttenn, F. Tron, P. Lesavre, et al.
Influence of oral contraceptive therapy on the activity of systemic lupus erythematosus.
Arthritis Rheum, 25 (1982), pp. 618-623
[13.]
H.A. Julkunen.
Oral contraceptives in systemic lupus erythematosus: side-effects and influence on the activity of SLE.
Scand J Rheumatol, 20 (1991), pp. 427-433
[14.]
J.P. Buyon, K.C. Kalunian, M.L. Skovron, M. Petri, R. Lahita, J. Merrill, et al.
Can women with systemic lupus erythematosus safely use exogenous estrogens?.
J Clin Rheumatol, 1 (1995), pp. 205-212
[15.]
M. Petri, M.Y. Kim, K.C. Kalunian, J. Grossman, B.H. Hahn, L.R. Sammaritano, et al.
Combined oral contraceptives in women with systemic lupus erythematosus.
N Engl J Med, 353 (2005), pp. 2550-2558
[16.]
J. Sánchez-Guerrero, A.G. Uribe, L. Jimánez-Santana, M. Mestanza-Peralta, P. Lara-Reyes, A.H. Seuc, et al.
A trial of contraceptive methods in women with systemic lupus erythematosus.
N Engl J Med, 353 (2005), pp. 2539-2549
[17.]
C.C. Mok, C.S. Lau, C.T. Ho, R.W. Wong.
Do flares of systemic lupus erythematosus decline after menopause?.
Scand J Rheumatol, 28 (1999), pp. 357-362
[18.]
C.C. Mok, C.S. Lau, R.W. Wong.
Use of exogenous estrogens in systemic lupus erythematosus.
Semin Arthritis Rheum, 30 (2001), pp. 426-435
[19.]
J. Sánchez-Guerrero, A. Villegas, A. Mendoza-Fuentes, J. Romero-Díaz, G. Moreno-Coutino, M.C. Cravioto.
Disease activity during the premenopausal and postmenopausal periods in women with systemic lupus erythematosus.
Am J Med, 111 (2001), pp. 464-468
[20.]
M.B. Urowitz, D. Ibanez, D. Jerome, D.D. Gladman.
The effect of menopause on disease activity in systemic lupus erythematosus.
J Rheumatol, 33 (2006), pp. 2192-2198
[21.]
M. Fernández, J. Calvo-Alen, G.S. Alarcón, J.M. Roseman, H.M. Bastian, B.J. Fessler, et al.
Systemic lupus erythematosus in a multiethnic US cohort (LUMINA): XXI. Disease activity, damage accrual, and vascular events in pre- and postmenopausal women.
Arthritis Rheum, 52 (2005), pp. 1655-1664
[22.]
J.E. Rossouw, G.L. Anderson, R.L. Prentice, A.Z. LaCroix, C. Kooperberg, M.L. Stefanick, et al.
Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial.
JAMA, 288 (2002), pp. 321-333
[23.]
S. Manzi, E.N. Meilahn, J.E. Rairie, C.G. Conte, T.A. Medsger, L. Jansen-McWilliams, et al.
Age-specific incidence rates of myocardial infarction and angina in women with systemic lupus erythematosus: comparison with the Framingham Study.
Am J Epidemiol, 145 (1997), pp. 408-415
[24.]
Y. Asanuma, A. Oeser, A.K. Shintani, E. Turner, N. Olsen, S. Fazio, et al.
Premature coronary-artery atherosclerosis in systemic lupus erythematosus.
N Engl J Med, 349 (2003), pp. 2407-2415
[25.]
M.J. Roman, B.A. Shanker, A. Davis, M.D. Lockshin, L. Sammaritano, R. Simantov, et al.
Prevalence and correlates of accelerated atherosclerosis in systemic lupus erythematosus.
N Engl J Med, 349 (2003), pp. 2399-2406
[26.]
N.K. Arden, M.E. Lloyd, T.D. Spector, G.R. Hughes.
Safety of hormone replacement therapy (HRT) in systemic lupus erythematosus (SLE).
Lupus, 3 (1994), pp. 11-13
[27.]
S. Kreidstein, M.B. Urowitz, D.D. Gladman, J. Gough.
Hormone replacement therapy in systemic lupus erythematosus.
J Rheumatol, 24 (1997), pp. 2149-2152
[28.]
J.P. Buyon, M.A. Petri, M.Y. Kim, K.C. Kalunian, J. Grossman, B.H. Hahn, et al.
The effect of combined estrogen and progesterone hormone replacement therapy on disease activity in systemic lupus erythematosus: a randomized trial.
Ann Intern Med, 142 (2005), pp. 953-962
[29.]
J. Sánchez-Guerrero, M. González-Pérez, M. Durand-Carbajal, P. Lara-Reyes, L. Jiménez-Santana, J. Romero-Díaz, et al.
Menopause hormonal therapy in women with systemic lupus erythematosus.
Arthritis Rheum, 56 (2007), pp. 3070-3079
[30.]
M. Fernández, G. McGwin, A.M. Bertoli, J. Calvo-Alen, G.S. Alarcón.
Systemic lupus erythematosus in a multiethnic cohort (LUMINAXXXIX): relationship between hormone replacement therapy and disease activity over time.
Lupus, 15 (2006), pp. 621-622
[31.]
M. Fernández, J. Calvo-Alen, A.M. Bertoli, H.M. Bastian, B.J. Fessler, G. McGwin, et al.
Systemic lupus erythematosus in a multiethnic US cohort (LUMINA L II): relationship between vascular events and the use of hormone replacement therapy in postmenopausal women.
J Clin Rheumatol, 13 (2007), pp. 261-265
[32.]
C.C. Beerendonk, P.A. Van Dop, D.D. Braat, J.M. Merkus.
Ovarian hyperstimulation syndrome: facts and fallacies.
Obstet Gynecol Surv, 53 (1998), pp. 439-449
[33.]
A. Ben-Chetrit, E. Ben-Chetrit.
Systemic lupus erythematosus induced by ovulation induction treatment.
Arthritis Rheum, 37 (1994), pp. 1614-1617
[34.]
P. Casoli, B. Tumiati, G. La Sala.
Fatal exacerbation of systemic lupus erythematosus after induction of ovulation.
J Rheumatol, 24 (1997), pp. 1639-1640
[35.]
A. Benshushan, A. Shushan, O. Paltiel, N. Mordel, N. Laufer.
Ovulation induction with clomiphene citrate complicated by deep vein thrombosis.
Eur J Obstet Gynecol Reprod Biol, 62 (1995), pp. 261-262
[36.]
D.L. Huong, B. Wechsler, D. Vauthier-Brouzes, P. Duhaut, N. Costedoat, G. Lefebvre, et al.
Importance of planning ovulation induction therapy in systemic lupus erythematosus and antiphospholipid syndrome: a single center retrospective study of 21 cases and 114 cycles.
Semin Arthritis Rheum, 32 (2002), pp. 174-188
[37.]
N. Guballa, L. Sammaritano, S. Schwartzman, J. Buyon, M.D. Lockshin.
Ovulation induction and in vitro fertilization in systemic lupus erythematosus and antiphospholipid syndrome.
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