Short-term therapy was effective in menopausal women
with autoimmune disease.
Menopausal women with lupus who take a short course of hormone replacement therapy (HRT) are not risking severe flare-ups of their disease, new research suggests.
These women did, however, experience a slight increase in mild-to-moderate flare-ups compared with women taking a placebo, according to the study in the June 21, 2005 issue of the Annals of Internal Medicine.
Both the study authors and the author of an accompanying editorial stress that, for women with lupus, the use of HRT should be weighed on an individual basis.
"This study, which was very carefully done and in a large number of patients, gives us comfort that severe flares are not increased with hormone replacement therapy," said Dr. Ellen Ginzler, chief of rheumatology at the State University of New York Downstate Medical Center in New York City. Ginzler was not involved with the study.
According to the Lupus Foundation of America, lupus is an autoimmune disease that causes inflammation in different parts of the body, often the skin, joints, blood and kidneys. Although the precise causes of the disease are not known, the immune systems of those with lupus attack their own cells and tissues.
Because the disease occurs 10 to 15 times more frequently in women than in men, and because lupus usually develops when a woman is still menstruating, some experts believe that estrogen plays a role in activating the condition.
As a result, many doctors have been reluctant to use HRT in menopausal women with lupus, lest it aggravate the disease.
In addition, Ginzler pointed out, many women with lupus have premature menopause because of their drugs or because of the inflammatory activity in their bodies.
"Women with lupus are likely to become menopausal at a younger age, and have to deal with menopausal symptoms," she said. HRT could help with some of these symptoms.
To see if HRT affected flare-ups in menopausal women with lupus, researchers at the Hospital for Joint Diseases in New York City conducted a randomized, double-blind, placebo-controlled study involving 351 menopausal women. The women received 12 months of treatment with HRT or a placebo.
Severe flare-ups were uncommon in both groups. "These would be life-threatening or organ-threatening," Ginzler said.
Mild-to-moderate flare-ups were higher in the HRT group: 1.14 flares per person-year in the HRT group vs. 0.86 flares per person-year in the placebo group.
The HRT group also had one death, one stroke, two deep vein thrombosis events, and one thrombosis, while the placebo group had only one deep vein thrombosis.
Some women with lupus have a higher predisposition for blood clots and related problems, but these women were disqualified from this latest study.
The key for women with lupus using HRT, as for most other women, is the duration of the therapy.
"We used to think that we would put women on HRT, and leave them on it for 10 years. Now, for the most part, we aren't recommending long-term HRT, but short-term, a year or more, we still consider," Ginzler said. "If you exclude those patients who have risk factors and shouldn't have been on HRT in the first place, we can feel comfortable with using postmenopausal HRT in patients with lupus."
By Amanda Gardner
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