Fernández M et al. (2005) 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: 1655–1664

Studies have suggested that lowered blood estrogen levels resulting from the female menopause decrease the activity of systemic lupus erythematosus (SLE); however, a recent investigation shows this not to be the case. In fact, age rather than menopausal status appears to predict damage accrual and vascular events in these patients.

Fernández et al. studied women from the multiethnic LUMINA cohort to investigate the association between menopausal status and a number of clinical and socioeconomic variables. At disease onset, 436 women were premenopausal and 82 postmenopausal. Premenopausal women were found to be at higher risk of renal involvement, severe proteinuria and MEMBRANOUS GLOMERULONEPHRITIS, and postmenopausal women of vascular arterial events and lipid abnormalities. Disease activity and other manifestations of disease were comparable between the groups. Damage accrual between baseline and last follow-up visit, however, was more frequent in postmenopausal women. Despite these results, on multivariate analysis age was found to independently contribute to damage accrual, renal involvement and vascular arterial events, suggesting that this, and not the menopause, is the main predictor of these events in women with SLE whose disease starts after menopause.

This study has limitations both in its classification of menopausal status and its gathering of data, but the results agree with those previously generated from the lumina cohort and the authors are confident in their validity. Their additional finding that Whites are more likely to contract SLE following the menopause than Hispanics and African Americans could warrant further investigation.