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Infections increase the risk of developing Sjögren's syndrome

Mofors, Johannes; Arkema, Elizabeth V; Björk, Albin; Westermark, Linnea; Kvarnström, Marika; Forsblad-d'Elia, Helena; Magnusson Bucher, Sara; Eriksson, Per; Mandl, Thomas LU and Nordmark, Gunnel, et al. (2019) In Journal of Internal Medicine
Abstract

OBJECTIVE: Environmental factors have been suggested in the pathogenesis of rheumatic diseases. We here investigated whether infections increase the risk of developing primary Sjögren's syndrome (pSS).

METHODS: Patients with pSS in Sweden (n=945) and matched controls from the general population (n=9,048) were included, and data extracted from the National Patient Register to identify infections occurring before pSS diagnosis during a mean observational time of 16.0 years. Data were analyzed using conditional logistic regression models. Sensitivity analyses were performed by varying exposure definition and adjusting for previous health care consumption.

RESULTS: A history of infection associated with an increased risk of pSS... (More)

OBJECTIVE: Environmental factors have been suggested in the pathogenesis of rheumatic diseases. We here investigated whether infections increase the risk of developing primary Sjögren's syndrome (pSS).

METHODS: Patients with pSS in Sweden (n=945) and matched controls from the general population (n=9,048) were included, and data extracted from the National Patient Register to identify infections occurring before pSS diagnosis during a mean observational time of 16.0 years. Data were analyzed using conditional logistic regression models. Sensitivity analyses were performed by varying exposure definition and adjusting for previous health care consumption.

RESULTS: A history of infection associated with an increased risk of pSS (OR 1.9, 95% CI 1.6-2.3). Infections were more prominently associated with development of SSA/SSB autoantibody positive pSS (OR 2.7, 95% CI 2.0-3.5). When stratifying the analysis by organ system infected, respiratory infections increased the risk of developing pSS, both in patients with (OR 2.9, 95% CI 1.8-4.7) and without autoantibodies (OR 2.1, 95% CI 1.1-3.8), while skin and urogenital infections only significantly associated with development of autoantibody-positive pSS (OR 3.2, 95% CI 1.8-5.5 and OR 2.7, 95% CI 1.7-4.2). Furthermore, a dose-response relationship was observed for infections and a risk to develop pSS with Ro/SSA and La/SSB antibodies. Gastrointestinal infections were not significantly associated with a risk of pSS.

CONCLUSIONS: Infections increase the risk of developing pSS, most prominently SSA/SSB autoantibody positive disease, suggesting that microbial triggers of immunity may partake in the pathogenetic process of pSS. This article is protected by copyright. All rights reserved.

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Journal of Internal Medicine
publisher
Wiley-Blackwell Publishing Ltd
external identifiers
  • scopus:85064556267
ISSN
1365-2796
DOI
10.1111/joim.12888
language
English
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yes
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145b39fb-fbee-48f3-bc46-1db03b7e1765
date added to LUP
2019-03-22 16:44:37
date last changed
2019-05-12 04:58:42
@article{145b39fb-fbee-48f3-bc46-1db03b7e1765,
  abstract     = {<p>OBJECTIVE: Environmental factors have been suggested in the pathogenesis of rheumatic diseases. We here investigated whether infections increase the risk of developing primary Sjögren's syndrome (pSS).</p><p>METHODS: Patients with pSS in Sweden (n=945) and matched controls from the general population (n=9,048) were included, and data extracted from the National Patient Register to identify infections occurring before pSS diagnosis during a mean observational time of 16.0 years. Data were analyzed using conditional logistic regression models. Sensitivity analyses were performed by varying exposure definition and adjusting for previous health care consumption.</p><p>RESULTS: A history of infection associated with an increased risk of pSS (OR 1.9, 95% CI 1.6-2.3). Infections were more prominently associated with development of SSA/SSB autoantibody positive pSS (OR 2.7, 95% CI 2.0-3.5). When stratifying the analysis by organ system infected, respiratory infections increased the risk of developing pSS, both in patients with (OR 2.9, 95% CI 1.8-4.7) and without autoantibodies (OR 2.1, 95% CI 1.1-3.8), while skin and urogenital infections only significantly associated with development of autoantibody-positive pSS (OR 3.2, 95% CI 1.8-5.5 and OR 2.7, 95% CI 1.7-4.2). Furthermore, a dose-response relationship was observed for infections and a risk to develop pSS with Ro/SSA and La/SSB antibodies. Gastrointestinal infections were not significantly associated with a risk of pSS.</p><p>CONCLUSIONS: Infections increase the risk of developing pSS, most prominently SSA/SSB autoantibody positive disease, suggesting that microbial triggers of immunity may partake in the pathogenetic process of pSS. This article is protected by copyright. All rights reserved.</p>},
  author       = {Mofors, Johannes and Arkema, Elizabeth V and Björk, Albin and Westermark, Linnea and Kvarnström, Marika and Forsblad-d'Elia, Helena and Magnusson Bucher, Sara and Eriksson, Per and Mandl, Thomas and Nordmark, Gunnel and Wahren-Herlenius, Marie},
  issn         = {1365-2796},
  language     = {eng},
  month        = {03},
  publisher    = {Wiley-Blackwell Publishing Ltd},
  series       = {Journal of Internal Medicine},
  title        = {Infections increase the risk of developing Sjögren's syndrome},
  url          = {http://dx.doi.org/10.1111/joim.12888},
  year         = {2019},
}