Self-reported flaring varies during the menstrual cycle in systemic lupus erythematosus compared with rheumatoid arthritis and fibromyalgia

Abstract

We studied self-reported flares before menses in SLE, RA and FM, and determined whether there were differences. 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. 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). 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.