Endometriosis Increase Risk of Antiphospholipid Syndrome: A Propensity Score Matched Cohort Study

Zhiyong Chen¹, Shiow-Ing Wang², James Cheng-Chung Wei³ and Sheng-Ming Dai¹, ¹Department of Rheumatology and Immunology, Shanghai Sixth People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China, ²Institute of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan, ³Chung Shan Medical University Hospital, Department of Rheumatology, Taichung, Taiwan

Meeting: ACR Convergence 2023

Keywords: antiphospholipid syndrome, Cohort Study, risk assessment

Session Information

Date: Tuesday, November 14, 2023

Title: Abstracts: Epidemiology & Public Health II

Session Type: Abstract Session

Session Time: 2:00PM-3:30PM

Background/Purpose: Patients with endometriosis have a variety of autoimmune abnormalities. Our objective was to investigate the risk of incident antiphospholipid syndrome (APS) in patients with endometriosis.

Methods: A retrospective cohort study was conducted using the US TriNetX (Cambridge, MA), a global federated health research network that provides real-time electronic medical record datasets. Propensity score matching was performed to adjust for demographic variables, comorbidities, and medication use. Cox proportional hazards models and subgroup analyses were used to estimate hazard ratios (HRs) for APS. The Kaplan–Meier method was used to plot the cumulative incidence curves. Subgroup analyses were also conducted, including age, obesity, and systemic lupus erythematosus (SLE). A sensitive analysis stratified by surgery confirmed endometriosis was performed.

Results: We identified50,078 patients with endometriosis among 16,602,603 female adults (20-60y) patients in the database. After propensity matching, 50,078 patients without endometriosis were analyzed for comparison. Compared to individuals without endometriosis, patients with endometriosis had a significantly higher risk of incident APS throughout the course of endometriosis (log rank test, p < 0.001). The HRs ranged from 1.82 (APS within 30 days to 1 year after index date, 95% confidence intervals [CI] 1.40–2.53) to 2.44 (APS within 30 days to any time after the index date, 95% CI 1.65–3.61). In the subgroup analyses, an increased risk of APS was observed in all ages, white race, and subgroups without smoking, obesity, asthma, inflammatory bowel disease, and SLE (HR range 1.85–2.84). Sensitivity analyses revealed that risk of APS increased significantly in patients with surgery confirmed endometriosis, but not in patients without surgery confirmed endometriosis.

Conclusion: Patients with endometriosis had a significantly higher risk (up to 284%) of APS. Our study provides strong evidence for the screening of APS in patients with endometriosis.

Forest plot of subgroup analysis

Disclosures: Z. Chen: None; S. Wang: None; J. Wei: Abbvie, 2, 5, 6, Amgen, 5, AstraZeneca, 6, BMS, 2, 5, 6, Celgene, 2, Chugai, 2, 6, Eisai, 2, 6, Eli Lilly, 2, 5, 6, Gilead, 5, GSK, 2, 5, Janssen, 2, 5, 6, Novartis, 2, 5, Pfizer, 2, 5, 6, Sanofi-Aventis, 2, SUN pharma, 5, TSH Taiwan, 2, UCB pharma, 2, 5; S. Dai: None.

To cite this abstract in AMA style:

Chen Z, Wang S, Wei J, Dai S. Endometriosis Increase Risk of Antiphospholipid Syndrome: A Propensity Score Matched Cohort Study [abstract]. Arthritis Rheumatol. 2023; 75 (suppl 9). https://acrabstracts.org/abstract/endometriosis-increase-risk-of-antiphospholipid-syndrome-a-propensity-score-matched-cohort-study/. Accessed .

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