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Mathias K, Mathias L, Amarnani A, Samko T, Lahita RG, Panush RS. Challenges of caring for transgender and gender diverse patients with rheumatic disease: presentation of seven patients and review of the literature. Curr Opin Rheumatol 2023; 35:117-127. [PMID: 35797514 DOI: 10.1097/bor.0000000000000894] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW As perspectives on sex and gender identity have evolved, there has been an increase in the practice of transgender medicine. Within rheumatology, however, there is a dearth of information about rheumatic disease in transgender and gender diverse (TGGD) individuals. This is important, as sex hormones affect the etiopathogenesis and expression of autoimmune diseases. We therefore sought to identify TGGD patients with rheumatic disease, review their clinical courses, and appraise existing literature about this population. RECENT FINDINGS Of 1053 patients seen at the Los Angeles County and University of Southern California Medical Center from 2019 through 2021, five transgender men and two transgender women with rheumatic disease were identified. Most patients' disease courses were not overtly impacted by gender affirming hormone therapy (GAHT). Six of seven patients had psychosocial barriers to care. Our systematic review found 11 studies with 11 transgender women and two transgender men. In 12 of 13 patients, GAHT possibly modulated the patients' rheumatic disease. SUMMARY Our observations suggest GAHT need not be a strict contraindication in TGGD patients with rheumatic disease. TGGD patients often face significant psychosocial barriers. Additional information about this population and empathy toward their health disparities are needed.
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Affiliation(s)
- Kristen Mathias
- Division of Rheumatology, Department of Medicine, The Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Lauren Mathias
- Division of Rheumatology, Department of Medicine, PIH Health, Los Angeles County, Los Angeles, California
| | - Abhimanyu Amarnani
- Division of Rheumatology, Department of Medicine, New York University Langone Health, New York, New York
| | - Tracey Samko
- Department of Internal Medicine and Pediatrics, Keck School of Medicine, Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, California
| | - Robert G Lahita
- Institute for Autoimmune and Rheumatic Disease, St. Joseph's Health, Patterson, New Jersey
| | - Richard S Panush
- Division of Rheumatology, Department of Medicine, Keck School of Medicine, University of Southern California, and Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, California, USA
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Salgado E, Romera-Baurés M, Beltran-Catalan E, Naredo E, Carreira PE, Garcia-Vivar M, Moreno-Muelas JV, Boteanu A, Calvo-Penades I, Sellas-Fernandez A, Valero M, Gomez-Reino JJ. Inmune-mediated inflammatory rheumatic diseases in transgender people: A scoping review. Semin Arthritis Rheum 2021; 52:151920. [PMID: 34872742 DOI: 10.1016/j.semarthrit.2021.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 10/25/2021] [Accepted: 10/25/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND In immune-mediated inflammatory rheumatic diseases (IMIRD), there are differences between cis-men and cis-women in epidemiology, clinical feature, therapeutic approach, treatment response, and prognosis. In transgender individuals, information concerning IMIRD is not substantial. The assessment of information concerning rheumatic diseases in transgenders is crucial because transgenders may undergo treatments with potential impacts on IMIRD. We aim to collect and discuss current knowledge on IMIRD in transgender individuals, determine the coverage of the literature, identify the knowledge gaps, and highlight opportunities for future research. METHODS We did a scoping review of publications collected through a systematic search of transgender patients with any IMIRD. Data sources were Medline, Embase, and Web of Knowledge. Synthesis of results and qualitative review of data information was collected in tables. A semi-quantification of the quality of the articles reporting clinical studies was performed. RESULTS There were 11 transwoman, and 3 transmen cases of systemic lupus erythematosus (5 cases), skin lupus erythematosus (2), systemic sclerosis (4), anti-synthetase syndrome (1), rheumatoid arthritis (1) and ankylosing spondylitis (1). Eleven were de novo cases and three had prior history of IMIRD and developed a comorbidity after starting hormone replacement therapy. The clinical expression of the disease was variable. Two transwomen and one transman developed thrombotic events. The lupus skin lesions in one transman improved following testosterone treatment. No clinical studies were identified. Quality of publications was disparate. CONCLUSION Although the number of cases is small, most cases of IMIRD occur in transwomen. The absence of solid data warrants caution in establishing recommendations regarding hormone replacement therapy in transgenders with IMIRD. There is an essential need for the consideration of cisgender and transgender particularities in future research on IMIRD.
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Affiliation(s)
- Eva Salgado
- Rheumatology Service, Complejo Hospitalario Universitario, c/ Ramon Puga Noguerol, 54, Ourense 32005 , Spain.
| | - Montserrat Romera-Baurés
- Rheumatology Service, Hospital Universitari Bellvitge, Carrer de la Feixa Llarga, s/n, Barcelona, L'Hospitalet de Llobregat 08907 , Spain
| | - Emma Beltran-Catalan
- Rheumatology Service, Hospital del Mar, Passeig Marítim de la Barceloneta, 25, 29, Barcelona 08003, Spain
| | - Esperanza Naredo
- Rheumatology Service, Hospital Universitario Fundación Jiménez Díaz, Av. de los Reyes Católicos 2, Madrid 28040, Spain
| | - Patricia E Carreira
- Rheumatology Service, Hospital Universitario Doce de Octubre, Av. de Córdoba s/n, Madrid 28041 , Spain
| | - Mariluz Garcia-Vivar
- Rheumatology Service, Hospital Universitario Basurto, Montevideo Etorb. 18, Bilbao 48013, Spain
| | - Jose V Moreno-Muelas
- Rheumatology Unit, Hospital Vall d' Hebrón, Passeig de la Vall d'Hebron 119, Barcelona 08035, Spain
| | - Alina Boteanu
- Rheumatology Service, Hospital Universitario Ramón y Cajal, M-607 km. 9, 100, Madrid 28034, Spain
| | - Inma Calvo-Penades
- Rheumatology Service, Hospital Universitario y Politécnico La Fe, Avinguda de Fernando Abril Martorell, 106, València 46026 , Spain
| | - Agusti Sellas-Fernandez
- Rheumatology Service, Hospital Universitari Arnau de Vilanova, Av. Alcalde Rovira Roure, 80, Lleida 25198, Spain
| | - Marta Valero
- Rheumatology Service, Hospital Universitario Ramón y Cajal, M-607, km. 9, 100, Madrid 28034, Spain
| | - Juan J Gomez-Reino
- Fundación IDIS, Rheumatology, Complejo Hospitalario Universitario de Santiago, Rúa da Choupana, s/n, Santiago de Compostela 15706 , Spain
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