Immunological predictors of endometriosis severity: A case–control study in reproductive-aged women in Iraq

Introduction: Endometriosis is a condition of chronic inflammation. Data imply an association with severe autoimmune spectrum. This paper analyses the relationship between autoimmune co-morbidities and phenotypes such as the more severe forms of disease, and assesses how well immunological markers may predict advanced disease. Methods: This case-control study included 100 women of reproductive age who had endometriosis verified by laparoscopy. Based on the presence of autoimmune diseases, such as antiphospholipid syndrome (APS), rheumatoid arthritis (RA), autoimmune thyroid disorders (ATD), systemic lupus erythematosus (SLE), and type 1 diabetes mellitus (T1D), participants were divided into the study group ( n = 40) and the control group ( n = 60). Results: Patients with autoimmune comorbidities had a higher proportion of advanced-stage disease (stage IV; 70.0% and 5.0%; p < 0.01), especially those with antiphospholipid syndrome (APS) and type-1 diabetes mellitus. The prevalence of deep infiltrating endometriosis was also higher in the autoimmune group ( p = 0.03). Autoimmunity was an independent predictor of stage IV endometriosis (AUC = 0.832). For APS, the association was very strong (OR: 48.9; p < 0.001), and similarly for T1DM (OR: 57.0; p = 0.002). Correlation analysis further showed that advanced disease is positively and significantly correlated with APS, RA, and ATD (all p < 0.001). Conclusion: The current study has emphasized that a pronounced relation exists between endometriosis and autoimmune disorders. Utilization of autoimmune screening tests can contribute to a better diagnosis and personalized treatment of endometriosis.