RESEARCH - Self-reported flaring varies during menstrual cycle in SLE, RA, and FM

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Rheumatology (2011) 50 (4): 703-708.

doi: 10.1093/rheumatology/keq360

Self-reported flaring varies during the menstrual cycle in systemic

lupus erythematosus compared with rheumatoid arthritis and

fibromyalgia

Kim Colangelo1, Sara Haig2, Bonner3, Caleb Zelenietz1 and Janet Pope1,2

1Department of Medicine, Schulich School of Medicine and Dentistry,

2Department of Medicine, Division of Rheumatology, St ph’s Health

Care, University of Western Ontario, London and 3Department of

Mathematics and Statistics, McMaster University, Hamilton, ON, Canada.

Abstract

Objective. We studied self-reported flares before menses in SLE, RA

and FM, and determined whether there were differences.

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 a 100-mm visual analogue scale (VAS) and menses.

Part 2: SLE, RA and FM patients were mailed a questionnaire about

menstrual cycle and disease changes.

Results. 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 were 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, the mean VAS

scores were 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 the surge. In RA, the

decreasing progesterone phase was different from the increasing

oestrogen phase for pain (P = 0.06).

Conclusion. 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.

http://rheumatology.oxfordjournals.org/content/50/4/703.abstract?etoc

Not an MD