Chronic pelvic pain associated with autoimmunity and systemic and peritoneal inflammation and treatment with immune modification.
OBJECTIVE
To determine the prevalence of chronic inflammation of the pelvic peritoneum, systemic inflammation and autoimmunity in chronic pelvic pain and to explore the significance of these findings and assess the response to treatment with immune modification.


METHODS
Prospective, observational clinical studies from 2 centers were performed on 3,238 women presenting with pelvic pain to determine the prevalence of chronic inflammation by biopsy when endometriosis was absent. A second study included 40 women with chronic pelvic pain not resulting from endometriosis; immunologic investigations were carried out and therapy instituted.


RESULTS
Chronic inflammation of the peritoneum, while not evident in the absence of pelvic pain, was present in 15.7% of women with chronic pelvic pain. In the second group, 10% had histologic evidence of chronic inflammation, 55% demonstrated evidence of systemic inflammation, and 37.5% were found to have autoimmune disorders. Chronic inflammation of the vagina was found in 42.5% and polycystic ovary syndrome in 22% of those with systemic inflammation. Twelve of the 40 were subsequently treated, with considerable success, with immune-modifying drugs, hydroxychloroquine and methotrexate.


CONCLUSIONS
Chronic pelvic pain is frequently associated with systemic inflammation, including autoimmune diseases. Peritoneal chronic inflammation is sometimes also associated. It is often successfully treated with immune-modifying drugs.
Thomson
John C
JC
Departments of Obstetrics and Gynecology, National Women's Health, Auckland, New Zealand. jthomson@world-net.co.nz
Redwine
David B
DB
D000293:Adolescent; D000328:Adult; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001323:Autoantibodies / Q000276:immunology; D001327:Autoimmune Diseases / Q000150:complications* / Q000276:immunology; D015551:Autoimmunity / Q000276:immunology; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007249:Inflammation / Q000276:immunology; D008875:Middle Aged; D017699:Pelvic Pain / Q000188:drug therapy / Q000276:immunology*; D010537:Peritoneum / Q000276:immunology; D011446:Prospective Studies
D018501:Antirheumatic Agents; D001323:Autoantibodies