Clinical implications of systemic lupus erythematosus without and with antiphospholipid syndrome in peri- and postmenopausal age

Abstract

Antiphospholipid syndrome (APS) in patients with systemic lupus erythematosus (SLE) displays a severe disease sub-phenotype with vascular manifestations ranging from peripheral thrombosis to neurologic and ophthalmic symptoms. The prevalence of morbidities including thrombosis, renal lesions, and cognitive impairment contributes to a higher risk of organ damage and a reduced quality of life in patients. In addition to the clinical heterogeneity, the diagnostic challenge is heightened in elderly patients as APS-related SLE is primarily diagnosed in young females. Many patients reach menopause due to the clinical association of premature menopause and improvements in diagnostic and therapeutic strategies in recent years. Although obstetric morbidity is not a concerning feature of the disease within this age group, a number of manifestations which may contribute to a decreased quality of life are present and must therefore not be disregarded. An improved prognosis derives from successful therapeutic regimens with minimal adverse effects in individual patients. The multifaceted management involves patient evaluation and risk stratification, followed by thromboprophylaxis efforts through the correction of modifiable risk factors, lifestyle recommendations, and pharmacological therapy. This review highlights the role of estradiol in the disease pathogenesis as well as the clinical complications and management of APS-related SLE in perimenopausal and postmenopausal patients.

One-decade study of distinct features, morbidity and mortality of systemic lupus erythematosus (an update on systemic lupus erythematosus in the Fars Province of Iran)

“…This finding is consistent with previous studies that also found that secondary antiphospholipid syndrome was mainly associated with SLE. [17][18][19] Furthermore, the most common comorbid disease in our patients was hypothyroidism; this finding is consistent with previous studies that detected a high prevalence of autoimmune thyroiditis and hypothyroidism in SLE patients. 20,21 In our survey, patients who had hypothyroidism presented with lower constitutional symptoms such as fatigue and fever, autoimmune hepatitis, depression, headache and hypertension.…”

Vasomotor Symptoms During Menopause: A Practical Guide on Current Treatments and Future Perspectives

“…68 More evaluation is needed regarding the impact of HT use on risk and severity of autoimmune conditions such as systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA), but those with antiphospholipid syndrome, a hypercoagulable state associated with SLE, should avoid HT. 69,70 Formulations and Approach to Prescribing…”

Progestogens as a component of menopausal hormone therapy: the right molecule makes the difference

“…In patients with systemic lupus erythematosus, the risk–benefit ratio of MHT must be weighed carefully due to the increased risk of VTE, cardiovascular events, and disease flare. 68 Conversely, as rheumatoid arthritis is a risk factor for osteoporosis, its presence may be an added consideration in symptomatic women who are candidates for MHT.…”