Sara S McCoy1, Emmanuel Sampene2, Alan N Baer3. 1. Department of Medicine, University of Wisconsin, School of Medicine and Public Health, Madison, WI. 2. Department of Biostatistics, University of Wisconsin School of Medicine and Public Health Madison, Wisconsin. 3. Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Abstract
OBJECTIVE: To test whether cumulative estrogen exposure, as determined by age at menarche, age at menopause, female hormone use, hysterectomy, and parity, has an effect on the development of primary Sjögren's syndrome (pSS). METHODS: We performed a case-control study of 2680 women from the Sjögren's International Collaborative Clinical Alliance (SICCA) registry, including 1320 pSS and 1360 participants with sicca symptoms but no key features of pSS ("sicca controls"). Composite estrogen score (CES) was calculated by point assignment for early menarche (≤ 10 years), high parity (>3 pregnancies), hysterectomy, use of hormone therapy, and late menopause (≥53 years). Cumulative menstrual cycling (CMC) was calculated as years menstruating minus time pregnant. RESULTS: Using a regression model adjusting for age, recruitment site, ethnicity, education, employment status, and smoking, we observed a progressive inverse trend between pSS and CES. The odds ratio (OR) and 95% confidence interval (CI) were as follows for the sicca control group: CES1, OR 0.8[95% CI, 0.67-0.99]; CES 2, OR 0.7[95% CI, 0.57-0.97]; CES 3, OR 0.5[95% CI, 0.30-0.86]. This finding was corroborated by analysis of CMC. At the highest level of CMC within the postmenopausal group there was a 24% reduction in cumulative sex hormone exposure among pSS registrants relative to controls. CONCLUSIONS: Women with pSS have lower estrogen exposure and CMC compared to a sicca control. Increasing estrogen exposure was negatively associated with development of pSS. Further longitudinal studies of sex hormone exposure in pSS are needed to confirm these findings. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
OBJECTIVE: To test whether cumulative estrogen exposure, as determined by age at menarche, age at menopause, female hormone use, hysterectomy, and parity, has an effect on the development of primary Sjögren's syndrome (pSS). METHODS: We performed a case-control study of 2680 women from the Sjögren's International Collaborative Clinical Alliance (SICCA) registry, including 1320 pSS and 1360 participants with sicca symptoms but no key features of pSS ("sicca controls"). Composite estrogen score (CES) was calculated by point assignment for early menarche (≤ 10 years), high parity (>3 pregnancies), hysterectomy, use of hormone therapy, and late menopause (≥53 years). Cumulative menstrual cycling (CMC) was calculated as years menstruating minus time pregnant. RESULTS: Using a regression model adjusting for age, recruitment site, ethnicity, education, employment status, and smoking, we observed a progressive inverse trend between pSS and CES. The odds ratio (OR) and 95% confidence interval (CI) were as follows for the sicca control group: CES1, OR 0.8[95% CI, 0.67-0.99]; CES 2, OR 0.7[95% CI, 0.57-0.97]; CES 3, OR 0.5[95% CI, 0.30-0.86]. This finding was corroborated by analysis of CMC. At the highest level of CMC within the postmenopausal group there was a 24% reduction in cumulative sex hormone exposure among pSS registrants relative to controls. CONCLUSIONS:Women with pSS have lower estrogen exposure and CMC compared to a sicca control. Increasing estrogen exposure was negatively associated with development of pSS. Further longitudinal studies of sex hormone exposure in pSS are needed to confirm these findings. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
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