Help for Menopausal Patients with Lupus?

Systemic lupus erythematosus (SLE) is a worldwide disease occurring predominantly in younger women, although the number of affected men is increasing. More middle-aged and older patients are also living with lupus because diagnoses are made later in life and patients are surviving longer. In fact, the mortality rate has changed dramatically. In the 1950s and early 1960s, 90% of patients with lupus were dead within 10 years of disease onset. Today, 90% of those affected are alive and doing well 10 years after diagnosis (1). Successful management has allowed many of the estimated 1 million to 1.5 million patients with SLE in the United States to live longer, more productive lives that extend into the pre- and postmenopausal years. Therefore, physiologic changes that accompany aging, such as menopause, require appropriate management.

In this issue, Buyon and colleagues (2) present the results of the Safety of Estrogens in Lupus Erythematosus, National Assessment (SELENA) trial. This trial aimed to measure the effect of hormone replacement therapy (HRT) on disease activity in lupus, a central issue in deciding about treatment of menopausal symptoms. The study sample consisted of 351 menopausal patients with lupus (mean age, 50 years), a high percentage of whom had inactive (72.5%) or stable-active (18.5%) disease. At study entry, all patients fulfilled at least 4 of the 11 American College of Rheumatology criteria for classification of SLE (3). They also met criteria for menopause: a follicle-stimulating hormone level greater than 40 mIU, a follicle-stimulating hormone level above the upper limit of the range of values in normal premenopausal women, or amenorrhea for 6 months if older than 50 years of age. Patients were randomly assigned to receive placebo (n = 177) or 0.625 mg of …