Background/Purpose: Polycystic ovary syndrome (PCOS) is characterized by hormonal abnormality, chronic anovulation, hyperandrogenism, and obesity. Due to the hormonal imbalance, we hypothesize that patients with PCOS may tend to develop inflammatory and immune disorders. To test this hypothesis, we sought to examine the frequency of systemic autoimmune diseases in PCOS.

Methods: A retrospective chart review of patients in a single center between January 2004 and February 2020 was conducted after approval by the Institutional Review Board. There were two groups consisting of PCOS patients aged 18 and older and age- and BMI-matched patients without PCOS in a ratio of 1:2. Exclusion criteria were endometrial or ovarian cancer. Electronic medical records (EMRs) were searched for individual rheumatic and systemic autoimmune diseases using ICD-9 and ICD-10 codes and for laboratory data. A comparison between PCOS and non-PCOS subjects was made in relevant parameters followed by a subgroup analysis between these groups based on weight categories: obese (BMI >=30), overweight (BMI 25-30), and nonobese (BMI< 25). Fisher Exact, Chi-square, Wilcoxon rank sum and Kruskal Wallis tests were used for statistical analysis.

Results: There were a total of 2,262 patients including 754 PCOS and 1,508 non-PCOS as control. The study population included 12.8% nonobese, 22.6% overweight, and 64.7% obese females with median age of 30.0 years and median BMI of 33.1. The rheumatic disorders and relevant laboratory data were compared between the two groups and are summarized (Tables 1 and 2). Our study showed that the frequency of RA was 2.25% in PCOS group and 1.26% in control (p=0.0747). The prevalence of RA in PCOS group more than doubled that (1%) in the general population, suggesting PCOS patients may tend to develop seropositive/seronegative inflammatory arthritis.  There was no significant difference in positive RF (0.27% VS 0.33%, p=1.0) or CCP (0.27% VS 0.07%, p=0.26) between groups. Our study also showed that compared with non-PCOS group, both SSc (0.0% VS 0.04%, p=0.0369) and UCTD (0.0% VS 0.53%, p=0.0123) were more prevalent in PCOS patients. Interestingly, PCOS patients were more likely to have ANA (11.41% VS 7.56%, p=0.0024) and ESR tested (19.10% VS 13.13%, p=0.0002) compared to controls. However, there was no significant difference in the positivity rate of ANA and other serologic markers between the two groups even with subgroup analysis of weight categories.  PCOS patients had significantly higher frequency of OA than non-PCOS patients (5.44% VS 2.92%, p=0.0030).

Conclusion: For the first time, our study suggests that PCOS patients may have higher frequency of systemic autoimmune diseases (seropositive/seronegative RA, SSc, and UCTD). The study is limited due to the inherent weakness of a retrospective study and search methodology using ICD codes. Future multicenter study with a larger sample size would be needed to validate the significance of our findings.

*Statistical comparison of percentage of positives between patients with PCOS and patients without.

RA=Rheumatoid Arthritis; SLE=Systemic Lupus Erythematosus; UCTD=Undifferentiated Connective Tissue Disease; SSc=Systemic Sclerosis; OA=Osteoarthritis

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/prevalence-of-systemic-autoimmune-diseases-in-polycystic-ovary-syndrome/