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Self-reported flaring varies during the menstrual cycle in systemic lupus erythematosus compared with rheumatoid arthritis and fibromyalgia
Rheumatology, 12/03/2010
Clinical Article
Colangelo K et al. – The authors studied self-reported flares before menses in SLE, RA and FM, and determined whether there were differences. There could have been recall bias and participants may have confused pre-menstrual syndrome with flares. However, there seem to be menstrual cycle flares in SLE, RA and FM.
Methods- Part 1: women blinded to study hypothesis having menses with SLE and RA completed a 100-day diary logging their pain, fatigue and disease activity on 100-mm visual analogue scale (VAS) and menses
- Part 2: SLE, RA and FM patients mailed questionnaire about menstrual cycle and disease changes
- Part 1: 28 patients with SLE and 21 with RA were included; 84% of SLE and 71% of RA patients had regular menses
- Patients with SLE had higher pain, fatigue and disease activity during menses than in the hormonal surge phase
- Patients with RA had increased pain, fatigue and disease activity during decreasing progesterone
- Part 2: 498 patients surveyed, of whom 56% responded (81 SLE, 136 RA and 61 FM)
- Those taking the oral contraceptive pill (OCP) ever since diagnosis were 52% with SLE, 41% with RA and 33% with FM (P=0.1)
- Those who flared before menses when not on OCP were 36% with SLE, 28% with RA and 54% with FM (P=0.08)
- In SLE patients, mean VAS scores worse during menses with average scores of 21.0 for pain, 26.7 for fatigue and 18.2 for disease activity vs 16.0 (P=0.04), 18.6 (P=0.004) and 11.4 (P=0.01) during surge
- In RA, decreasing progesterone phase different from increasing oestrogen phase for pain (P=0.06)
