Abstract
Pathogenesis of endometriosis is still unclear and a role of both innate and adaptive immune system has been postulated. Some recent findings have revealed an increased risk to have concomitant autoimmune disease in women with endometriosis, but no study so far has investigated whether this association could affect endometriosis severity and stage. We retrospectively reviewed medical patients’ notes of women with a confirmed diagnosis of endometriosis who referred to our endometriosis outpatient clinic between January 2015 and December 2019. Cases (endometriosis and an autoimmune disease) were matched in a 1:3 ratio by age and study period with controls (endometriosis without history of autoimmunity). At univariate logistic analysis, concomitant autoimmunity (OR 2.63, 95% CI 1.64–4.21, p < 0.001) and the number of laparoscopic procedures performed (OR 2.81, 95% CI 1.45–5.43, p = 0.002) emerged as factors significantly associated with the likelihood of stage IV endometriosis. In the multivariate logistic regression model, concomitant autoimmunity remained a significant predictor of stage IV endometriosis (OR 2.54, 95% CI 1.57–4.10, p = 0.004), whereas the association between the number of laparoscopic procedures performed and stage IV endometriosis was found to be of borderline-significance (OR 2.70, 95% 1.37–5.30, p = 0.050). Our findings suggest that endometriosis is more severe in patients who are also affected by autoimmune disturbances after controlling for relevant confounders.
Highlights
Baseline characteristics Age at evaluation Age at diagnostic LS Age at symptoms onset Time from LS Number of surgical procedures Number of clinical evaluations r-AFS stage I II III IV Type of endometriosis ovarian endometrioma (OMA) superficial peritoneal endometriosis (SPE) deep infiltrating endometriosis (DIE) Hormone therapy Any None Not known
The two groups were comparable in terms of age at laparoscopy (31.1 ± 6.2 versus 30.1 ± 5.4 in cases and controls respectively, p = 0.761) and time interval between laparoscopy and inclusion in the study (7.7 ± 5.9 versus 8.0 ± 5.7 years in cases and controls respectively, p = 0.703).The proportion of women using hormonal treatment for endometriosis at the time of inclusion in the study was comparable between the two groups (44.8% versus 47.7% in cases and controls respectively, p = 0.617)
Concomitant autoimmunity and the number of laparoscopic procedures performed emerged as factors significantly associated with the likelihood of stage IV endometriosis (Table 3)
Summary
Baseline characteristics Age at evaluation (years) Age at diagnostic LS (years) Age at symptoms onset (years) Time from LS (years) Number of surgical procedures Number of clinical evaluations r-AFS stage I II III IV Type of endometriosis OMA SPE DIE Hormone therapy Any None Not known. Some of genetic polymorphisms in the autoimmunity genes have been investigated in endometriosis, with inconsistent r esults. Some of genetic polymorphisms in the autoimmunity genes have been investigated in endometriosis, with inconsistent r esults12 These findings have led to the idea of endometriosis as a unique immunological scenario outlining the plausible association between endometriosis and immunity/autoimmunity. No study has so far investigated whether the observed association between endometriosis and autoimmunity might be related to the severity of endometriosis. To shed more light into the possible link between endometriosis and autoimmunity, we designed a matched case–control study to investigate whether the concomitant presence of autoimmune diseases is associated with different stages of endometriosis
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