{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T00:34:02Z","timestamp":1792370042558,"version":"4.4.0"},"reference-count":48,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2020,8,31]],"date-time":"2020-08-31T00:00:00Z","timestamp":1598832000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis Care & Research"],"published-print":{"date-parts":[[2020,9]]},"abstract":"Objective<\/jats:title>To test whether cumulative estrogen exposure, as determined by age at menarche, age at menopause, female hormone use, hysterectomy, and parity, have an effect on the development of primary Sj\u00f6gren's syndrome (SS<\/jats:styled-content>).<\/jats:p><\/jats:sec>Methods<\/jats:title>We performed a case\u2013<\/jats:italic>control study of 2,680 women from the Sj\u00f6gren's International Collaborative Clinical Alliance registry, including 1,320 registrants with primary SS<\/jats:styled-content> and 1,360 with sicca symptoms but no key features of primary SS<\/jats:styled-content> (sicca controls). The composite estrogen score (CES<\/jats:styled-content>) was calculated by point assignment for early menarche (age \u226410 years), high parity (>3 pregnancies), hysterectomy, female hormone use, and late menopause (age \u226553 years). Cumulative menstrual cycling (CMC<\/jats:styled-content>) was calculated as years menstruating minus time pregnant.<\/jats:p><\/jats:sec>Results<\/jats:title>Using a regression model that adjusted for age, recruitment site, ethnicity, education, employment status, and smoking, we observed a progressive inverse trend between primary SS<\/jats:styled-content> and CES<\/jats:styled-content>. The odds ratio (OR<\/jats:styled-content>) and 95% confidence interval (95% CI<\/jats:styled-content>) were as follows for the sicca control group: CES<\/jats:styled-content> 1, OR<\/jats:styled-content> 0.81 (95% CI<\/jats:styled-content> 0.67\u20130.99); CES<\/jats:styled-content> 2, OR<\/jats:styled-content> 0.74 (95% CI<\/jats:styled-content> 0.57\u20130.97); CES<\/jats:styled-content> 3, OR<\/jats:styled-content> 0.50 (95% CI<\/jats:styled-content> 0.30\u20130.86). This trend was corroborated by analysis of CMC<\/jats:styled-content>. At the highest level of CMC<\/jats:styled-content> within the postmenopausal group there was a 24% reduction in cumulative sex hormone exposure among primary SS<\/jats:styled-content> participants relative to controls.<\/jats:p><\/jats:sec>Conclusion<\/jats:title>Women with primary SS<\/jats:styled-content> have lower estrogen exposure and CMC<\/jats:styled-content> compared to sicca controls. Increasing estrogen exposure was negatively associated with development of primary SS<\/jats:styled-content>. Further longitudinal studies of sex hormone exposure in primary SS<\/jats:styled-content> are needed to confirm these findings.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acr.24014","type":"journal-article","created":{"date-parts":[[2019,6,25]],"date-time":"2019-06-25T10:23:25Z","timestamp":1561458205000},"page":"1315-1322","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":61,"title":["Association of Sj\u00f6gren's Syndrome With Reduced Lifetime Sex Hormone Exposure: A Case\u2013Control Study"],"prefix":"10.1002","volume":"72","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5293-4185","authenticated-orcid":false,"given":"Sara S.","family":"McCoy","sequence":"first","affiliation":[{"name":"University of Wisconsin School of Medicine and Public Health Madison"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel","family":"Sampene","sequence":"additional","affiliation":[{"name":"University of Wisconsin School of Medicine and Public Health Madison"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan N.","family":"Baer","sequence":"additional","affiliation":[{"name":"Johns Hopkins University School of Medicine Baltimore Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,8,31]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2014-205375"},{"key":"e_1_2_6_3_1","first-page":"1259","article-title":"Low serum dehydroepiandrosterone sulfate in women with primary Sj\u00f6gren's syndrome as an isolated sign of impaired HPA axis function","volume":"28","author":"Valtysdottir ST","year":"2001","journal-title":"J Rheumatol"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.53.6.425-a"},{"key":"e_1_2_6_5_1","first-page":"2259","article-title":"Joint pain with aromatase inhibitors: abnormal frequency of Sj\u00f6gren's syndrome","volume":"34","author":"Laroche M","year":"2007","journal-title":"J Rheumatol"},{"key":"e_1_2_6_6_1","first-page":"378","article-title":"Risk factors for Sj\u00f6gren's syndrome: a case\u2010control study","volume":"25","author":"Priori R","year":"2007","journal-title":"Clin Exp Rheumatol"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.53.9.569"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.30381"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780310302"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780400928"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.24397"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.21591"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2016-210571"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.parkreldis.2014.08.003"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(00)03622-9"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1209993"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.27336"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1023\/A:1020684821837"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwq321"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1158\/1055-9965.EPI-04-0465"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/155.4.339"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12872-015-0172-4"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0172054"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.psyneuen.2013.08.005"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.0405099101"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9440(10)63505-5"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1084\/jem.20080174"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.exer.2014.09.001"},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1297-319X(03)00151-9"},{"key":"e_1_2_6_30_1","first-page":"1291","article-title":"The prevalence of hyperprolactinemia in patients with primary Sj\u00f6gren's syndrome","volume":"26","author":"Haga HJ","year":"1999","journal-title":"J Rheumatol"},{"key":"e_1_2_6_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tripleo.2003.10.033"},{"key":"e_1_2_6_32_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1582-4934.2009.00727.x"},{"key":"e_1_2_6_33_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.39214"},{"key":"e_1_2_6_34_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.23701"},{"key":"e_1_2_6_35_1","doi-asserted-by":"publisher","DOI":"10.1172\/JCI78082"},{"key":"e_1_2_6_36_1","doi-asserted-by":"publisher","DOI":"10.4049\/jimmunol.0804355"},{"key":"e_1_2_6_37_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.39560"},{"key":"e_1_2_6_38_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10238-015-0404-z"},{"key":"e_1_2_6_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/0167-5699(93)90160-M"},{"key":"e_1_2_6_40_1","doi-asserted-by":"publisher","DOI":"10.1038\/nature07336"},{"key":"e_1_2_6_41_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.1233521"},{"key":"e_1_2_6_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.immuni.2013.08.013"},{"key":"e_1_2_6_43_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/key392"},{"key":"e_1_2_6_44_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/ket349"},{"key":"e_1_2_6_45_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005792-200207000-00003"},{"key":"e_1_2_6_46_1","doi-asserted-by":"publisher","DOI":"10.1191\/096120398678920019"},{"key":"e_1_2_6_47_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwh188"},{"key":"e_1_2_6_48_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.20621"},{"key":"e_1_2_6_49_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kew023"}],"container-title":["Arthritis Care & Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Facr.24014","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/acr.24014","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/acr.24014","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/acr.24014","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,2]],"date-time":"2025-10-02T16:17:00Z","timestamp":1759421820000},"score":1,"resource":{"primary":{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/10.1002\/acr.24014"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,8,31]]},"references-count":48,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2020,9]]}},"alternative-id":["10.1002\/acr.24014"],"URL":"https:\/\/doi.org\/10.1002\/acr.24014","archive":["Portico"],"relation":{},"ISSN":["2151-464X","2151-4658"],"issn-type":[{"value":"2151-464X","type":"print"},{"value":"2151-4658","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,8,31]]},"assertion":[{"value":"2018-11-09","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-06-18","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-08-31","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}