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Olivieri B, Betterle C, Zanoni G. Vaccinations and Autoimmune Diseases. Vaccines (Basel) 2021; 9:vaccines9080815. [PMID: 34451940 PMCID: PMC8402446 DOI: 10.3390/vaccines9080815] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/12/2021] [Accepted: 07/15/2021] [Indexed: 12/12/2022] Open
Abstract
Vaccines represent one of the most effective measures of public health medicine, saving countless lives and preventing lifelong disabilities. Vaccines are extremely safe, however, no vaccine is completely free from risks and adverse events can occur following vaccination. An adverse event following immunization (AEFI) may be a true adverse reaction caused by the vaccine or an event that temporally occurred after immunization but is not caused by it. Among the adverse reactions to vaccines, one of the most feared is the triggering of autoimmune diseases, which are a heterogeneous group of disorders characterized by dysregulation of the immune system. Currently, no mechanisms have been demonstrated that could explain the correlation between vaccination and the development of autoimmune diseases. Furthermore, epidemiological studies do not support the hypothesis that vaccines cause systemic autoimmune diseases. The only confirmed associations, although very rare, are those between the flu vaccine and Guillain-Barré syndrome, especially with old vaccine preparations, and measles-mumps-rubella (MMR) vaccine and thrombocytopenia. Due to the SARS-CoV2 pandemic, new types of vaccines have been developed and are now available. Close vaccine safety-surveillance is currently underway for these new vaccines.
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Affiliation(s)
- Bianca Olivieri
- Department of Medicine, School of Specialization in Allergy and Clinical Immunology, University of Verona, 37134 Verona, Italy;
| | - Corrado Betterle
- Department of Medicine (DIMED), Clinical Immunology and Allergy, University of Padua, 35128 Padua, Italy;
| | - Giovanna Zanoni
- Immunology Unit, University Hospital, 37134 Verona, Italy
- Correspondence:
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Tung CH, Li CY, Chen YC, Chen YC. Association between nucleos(t)ide analogue therapy for hepatitis B and Sjögren's syndrome: 15-year analysis of the national database of Taiwan. J Viral Hepat 2021; 28:809-816. [PMID: 33550705 DOI: 10.1111/jvh.13481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/23/2021] [Indexed: 12/09/2022]
Abstract
Hepatitis B virus (HBV) infection has been proposed to play a role in the development of Sjögren's syndrome. However, to date, there are no reports on the risk of SS in HBV-infected patients following nucleos(t)ide analogue therapy. Due to Taiwan has higher prevalence of HBV infection and therapy was well recorded in the Taiwan's single-payer national health insurance database, we hypothesized that a long-term retrospective analysis of the risk of Sjögren's syndrome in HBV-infected patients following nucleotide therapy will increase our understanding of Sjögren's syndrome development following HBV infection. We identified 26,147 adults diagnosed with HBV infection between 1997 and 2012 in claims data. Finally, a total of 3268 HBV-infected patients who ever received nucleotide therapy (treated cohort) were frequency-matched on age and sex at 1:4 ratios to select a control group of 13,072 counterparts without therapy (untreated cohort). To identify Sjögren's syndrome risk, competing risk analysis adjusted for all covariates was performed. The risk was significantly lower in the treated cohort (15-year cumulative incidence, 2.4%; 95% confidence interval [CI], 1.4%-3.7%) than in the untreated cohort (7.1%; 95% CI, 2.5%-15.2%) (p = .015), and the adjusted HR was 0.6 (95% CI, 0.41-0.88; p = .009). Multivariable stratified analysis further verified the consistent associations between nucleoside therapy and risk reduction of Sjögren's syndrome across all strata. Our finding suggests that HBV infection treated with nucleotides is associated with lower risk of Sjögren's syndrome, implying a potential role of HBV infection in the development of Sjögren's syndrome.
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Affiliation(s)
- Chien-Hsueh Tung
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chung-Yi Li
- Department and Graduate Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan.,Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Yen-Chun Chen
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Yi-Chun Chen
- School of Medicine, Tzu Chi University, Hualien, Taiwan.,Division of Nephrology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
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Borba V, Malkova A, Basantsova N, Halpert G, Andreoli L, Tincani A, Amital H, Shoenfeld Y. Classical Examples of the Concept of the ASIA Syndrome. Biomolecules 2020; 10:biom10101436. [PMID: 33053910 PMCID: PMC7600067 DOI: 10.3390/biom10101436] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/13/2020] [Accepted: 09/25/2020] [Indexed: 02/06/2023] Open
Abstract
Autoimmune/inflammatory syndrome induced by adjuvants (ASIA) was first introduced in 2011 by Shoenfeld et al. and encompasses a cluster of related immune mediated diseases, which develop among genetically prone individuals as a result of adjuvant agent exposure. Since the recognition of ASIA syndrome, more than 4400 documented cases have been reported so far, illustrated by heterogeneous clinical manifestations and severity. In this review, five enigmatic conditions, including sarcoidosis, Sjögren's syndrome, undifferentiated connective tissue disease, silicone implant incompatibility syndrome (SIIS), and immune-related adverse events (irAEs), are defined as classical examples of ASIA. Certainly, these disorders have been described after an adjuvant stimulus (silicone implantation, drugs, infections, metals, vaccines, etc.) among genetically predisposed individuals (mainly the HLA-DRB1 and PTPN22 gene), which induce an hyperstimulation of the immune system resulting in the production of autoantibodies, eventually leading to the development of autoimmune diseases. Circulating autonomic autoantibodies in the sera of patients with silicone breast implants, as well as anatomopathological aspects of small fiber neuropathy in their skin biopsies have been recently described. To our knowledge, these novel insights serve as a common explanation to the non-specific clinical manifestations reported in patients with ASIA, leading to the redefinition of the ASIA syndrome diagnostic criteria.
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Affiliation(s)
- Vânia Borba
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer 5265601, Israel; (V.B.); (G.H.); (H.A.)
| | - Anna Malkova
- Laboratory of the Mosaic of Autoimmunity, Saint Petersburg State University, 5265601 Saint-Petersburg, Russia; (A.M.); (N.B.)
| | - Natalia Basantsova
- Laboratory of the Mosaic of Autoimmunity, Saint Petersburg State University, 5265601 Saint-Petersburg, Russia; (A.M.); (N.B.)
| | - Gilad Halpert
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer 5265601, Israel; (V.B.); (G.H.); (H.A.)
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
| | - Laura Andreoli
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy; (L.A.); (A.T.)
- Rheumatology and Clinical Immunology, ASST Spedali Civili, 25123 Brescia, Italy
| | - Angela Tincani
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy; (L.A.); (A.T.)
- Rheumatology and Clinical Immunology, ASST Spedali Civili, 25123 Brescia, Italy
- Ministry of Health of the Russian Federation, Sechenov First Moscow State Medical University, 119146 Moscow, Russia
| | - Howard Amital
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer 5265601, Israel; (V.B.); (G.H.); (H.A.)
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
| | - Yehuda Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer 5265601, Israel; (V.B.); (G.H.); (H.A.)
- Laboratory of the Mosaic of Autoimmunity, Saint Petersburg State University, 5265601 Saint-Petersburg, Russia; (A.M.); (N.B.)
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
- Correspondence:
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Björk A, Mofors J, Wahren-Herlenius M. Environmental factors in the pathogenesis of primary Sjögren's syndrome. J Intern Med 2020; 287:475-492. [PMID: 32107824 DOI: 10.1111/joim.13032] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Primary Sjögren's syndrome (SS) is a systemic autoimmune disease in which exocrine organs, primarily the salivary and lacrimal glands, are targets of chronic inflammation, leading to severe dryness of eyes and mouth. Fatigue and arthralgia are also common, and extraglandular manifestations involving the respiratory, nervous and vascular systems occur in a subset of patients. Persistent activation of the type I interferon system, and autoreactive B and T cells with production of disease-associated autoantibodies are central to the pathogenesis. Genetic polymorphisms that associate with an increased risk of SS have been described, though the risk-increase contributed by the respective variant is generally low. It is thus becoming increasingly clear that genetics cannot alone account for the development of SS and that other, presumably exogenous, factors must play a critical role. Relatively few studies have investigated exposure to potential risk factors prior to SS disease onset. Rather, many factors have been studied in prevalent cases. In this review, we summarize current literature on exogenous factors in the pathogenesis of SS including infections, hormones, smoking, solvents and additional compounds. We delineate for which factors there is current evidence of increased disease risk, and for which our present knowledge is confined to suggesting their role in SS pathogenesis. Finally, we outline future perspectives in the continued search for environmental risk factors for SS, a research area of great importance considering the possibilities for preventive measures.
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Affiliation(s)
- A Björk
- From the, Division of Rheumatology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - J Mofors
- From the, Division of Rheumatology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - M Wahren-Herlenius
- From the, Division of Rheumatology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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Liu X, Xing H, Gao W, Yu D, Zhao Y, Shi X, Zhang K, Li P, Yu J, Xu W, Shan H, Zhang K, Bao W, Fu X, Yang S, Wang S. A functional variant in the OAS1 gene is associated with Sjögren's syndrome complicated with HBV infection. Sci Rep 2017; 7:17571. [PMID: 29242559 PMCID: PMC5730593 DOI: 10.1038/s41598-017-17931-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 12/04/2017] [Indexed: 02/06/2023] Open
Abstract
Hepatitis B virus (HBV) has been suspected to contribute to several autoimmune diseases, including Sjögren's syndrome (SS), although the exact mechanism is unknown. The 2'-5' oligoadenylate synthetase (OAS1) is one of the most important components of the immune system and has significant antiviral functions. We studied a polymorphism rs10774671 of OAS1 gene in Han Chinese descent. The minor allele G was significantly associated with a decreased risk for SS, anti-SSA-positive SS, and anti-SSA-positive SS complicated with HBV infection, which have not been seen in anti-SSA-negative SS and HBcAb-negative SS patients. Gene expression analysis showed that the risk-conferring A allele was correlated with lower expression of p46 and increased expression of p42, p48, and p44. A functional study of enzymatic activities revealed that the p42, p44, and p48 isoforms display a reduced capacity to inhibit HBV replication in HepG2 cells compared to the normal p46 isoform. Our data demonstrated that the functional variant, rs10774671, is associated with HBV infection and anti-SSA antibody-positive SS. The SAS variant switches the primary p46 isoform to three alternatives with decreased capacities to inhibit HBV replication. These data indicated that individuals harboring the risk allele might be susceptible to hepatitis B infection and SS development.
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Affiliation(s)
- Xianjun Liu
- The Bethune Institute of Epigenetic Medicine, The First Hospital of Jilin University, Changchun, China
| | - Hongcun Xing
- College of Life Sciences, The University of Jilin, Changchun, China
| | - Wenjing Gao
- The Bethune Institute of Epigenetic Medicine, The First Hospital of Jilin University, Changchun, China
- College of Life Sciences, The University of Jilin, Changchun, China
| | - Di Yu
- The Bethune Institute of Epigenetic Medicine, The First Hospital of Jilin University, Changchun, China
| | - Yuming Zhao
- College of Life Sciences, The University of Jilin, Changchun, China
| | - Xiaoju Shi
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, China
| | - Kun Zhang
- The Research Center, The Second Hospital of Jilin University, Changchun, China
| | - Pingya Li
- The College of Pharmacy, The University of Jilin, Changchun, China
| | - Jiaao Yu
- Department of Burn Surgery, The First Hospital of Jilin University, Changchun, China
| | - Wei Xu
- Department of Clinical Laboratory, The First Hospital of Jilin University, Changchun, China
| | - Hongli Shan
- Department of Clinical Laboratory, The First Hospital of Jilin University, Changchun, China
| | - Kaiyu Zhang
- Department of infectious Diseases, The First Hospital of Jilin University, Changchun, China
| | - Wanguo Bao
- Department of infectious Diseases, The First Hospital of Jilin University, Changchun, China
| | - Xueqi Fu
- College of Life Sciences, The University of Jilin, Changchun, China
| | - Sirui Yang
- Center of Pediatrics, Institute of Pediatrics, The First Hospital of Jilin University, Changchun, China.
| | - Shaofeng Wang
- The Bethune Institute of Epigenetic Medicine, The First Hospital of Jilin University, Changchun, China.
- Center of Pediatrics, Institute of Pediatrics, The First Hospital of Jilin University, Changchun, China.
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Digestive Involvement in Primary Sjögren's Syndrome. THE DIGESTIVE INVOLVEMENT IN SYSTEMIC AUTOIMMUNE DISEASES 2017. [DOI: 10.1016/b978-0-444-63707-9.00015-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Colafrancesco S, Perricone C, Priori R, Valesini G, Shoenfeld Y. Sjögren's syndrome: another facet of the autoimmune/inflammatory syndrome induced by adjuvants (ASIA). J Autoimmun 2014; 51:10-6. [PMID: 24774584 DOI: 10.1016/j.jaut.2014.03.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 03/21/2014] [Indexed: 01/26/2023]
Abstract
Recently, a new syndrome, namely the "Autoimmune/inflammatory syndrome induced by adjuvants" (ASIA) has been defined. In this syndrome different conditions characterized by common signs and symptoms and induced by the presence of an adjuvant are included. The adjuvant is a substance capable of boosting the immune response and of acting as a trigger in the development of autoimmune diseases. Post-vaccination autoimmune phenomena represent a major issue of ASIA. Indeed, despite vaccines represent a mainstay in the improvement of human health, several of these have been implicated as a potential trigger for autoimmune diseases. Sjogren's Syndrome (SjS) is a systemic chronic autoimmune inflammatory disease characterized by the presence of an inflammatory involvement of exocrine glands accompanied by systemic manifestations. Own to the straight association between infectious agents exposure (mainly viruses) and sicca syndrome development, the possible link between vaccine and SjS is not surprising. Indeed, a few cases of SjS following vaccine delivery have been reported. At the same extent, the induction of SjS following silicone exposure has been described too. Thus, the aim of this review was to focus on SjS and its possible development following vaccine or silicone exposure in order to define another possible facet of the ASIA syndrome.
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Affiliation(s)
- S Colafrancesco
- Department of Internal Medicine and Medical Specialities, Rheumatology Unit, Sapienza University of Rome, Italy; The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
| | - C Perricone
- Department of Internal Medicine and Medical Specialities, Rheumatology Unit, Sapienza University of Rome, Italy; The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
| | - R Priori
- Department of Internal Medicine and Medical Specialities, Rheumatology Unit, Sapienza University of Rome, Italy
| | - G Valesini
- Department of Internal Medicine and Medical Specialities, Rheumatology Unit, Sapienza University of Rome, Italy
| | - Y Shoenfeld
- The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel; Incumbent of the Laura Schwarz-Kipp Chair for Research of Autoimmune Diseases, Sackler Faculty of Medicine, Tel Aviv University, Israel.
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Soriano A, Afeltra A, Shoenfeld Y. Immunization with vaccines and Sjögren's syndrome. Expert Rev Clin Immunol 2014; 10:429-35. [PMID: 24646084 DOI: 10.1586/1744666x.2014.902312] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Sjögren's syndrome (SjS) is a systemic autoimmune disease with complex pathogenesis and still unknown etiology. Infections are listed among the main environmental factors triggering the disease in genetically predisposed individuals. Among other environmental factors, the role of immunization with vaccines in the etiopathogenesis of SjS has not yet been elucidated. Although immunization with vaccines is safe for the majority of subjects, in rare cases it can trigger or exacerbate autoimmune and rheumatic inflammatory conditions. In this paper we investigate the possible links between immunization with vaccines and the pathogenesis of SjS. The current scientific evidence about safety and efficacy of vaccines in the course of SjS are also reviewed.
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Affiliation(s)
- Alessandra Soriano
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
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Zeron PB, Retamozo S, Bové A, Kostov BA, Sisó A, Ramos-Casals M. Diagnosis of Liver Involvement in Primary Sjögren Syndrome. J Clin Transl Hepatol 2013; 1:94-102. [PMID: 26355632 PMCID: PMC4521276 DOI: 10.14218/jcth.2013.00011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 10/04/2013] [Accepted: 10/05/2013] [Indexed: 02/06/2023] Open
Abstract
Liver involvement was one of the first extraglandular manifestations to be reported in patients with primary Sjögren syndrome (SS). In the 1990s, a study of liver involvement in patients with primary SS integrated the evaluation of clinical signs of liver disease, liver function and a complete panel of autoantibodies. Recent developments in the field of hepatic and viral diseases have significantly changed the diagnostic approach to liver involvement in SS. The most recent studies have shown that, after eliminating hepatotoxic drugs and fatty liver disease, the two main causes of liver disease in primary SS are chronic viral infections and autoimmune liver diseases. The differential diagnosis of liver disease in primary SS (viral vs autoimmune) is clinically important, since the two processes require different therapeutic approaches and have different prognoses. With respect to viral infections, chronic HCV infection is the main cause of liver involvement in SS patients from the Mediterranean area, while chronic HBV infection may be the main cause of liver involvement in SS patients from Asian countries. After eliminating viral hepatitis, primary biliary cirrhosis (PBC) should be considered the main cause of liver disease in primary SS. PBC-related SS patients may have a broad spectrum of abnormalities of the liver, including having no clinical or analytical data suggestive of liver disease. Autoimmune hepatitis (AIH) is the second most frequently found autoimmune liver disease to be associated with SS (all reported cases are type I), and nearly 10% of these patients have an AIH-PBC overlap. Finally, IgG4-related disease must be investigated in patients with SS presenting with sclerosing cholangitis, especially when autoimmune pancreatitis or retroperitoneal fibrosis are also present.
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Affiliation(s)
- Pilar Brito Zeron
- Sjögren Syndrome Research Group (AGAUR), Laboratory of Autoimmune Diseases Josep Font, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, Spain
| | - Soledad Retamozo
- Sjögren Syndrome Research Group (AGAUR), Laboratory of Autoimmune Diseases Josep Font, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, Spain
| | - Albert Bové
- Sjögren Syndrome Research Group (AGAUR), Laboratory of Autoimmune Diseases Josep Font, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, Spain
| | - Belchin Adriyanov Kostov
- Primary Care Research Group, IDIBAPS, Centre d'Assistència_Primària ABS Les Corts, GESCLINIC, Barcelona, Spain
| | - Antoni Sisó
- Primary Care Research Group, IDIBAPS, Centre d'Assistència_Primària ABS Les Corts, GESCLINIC, Barcelona, Spain
| | - Manuel Ramos-Casals
- Sjögren Syndrome Research Group (AGAUR), Laboratory of Autoimmune Diseases Josep Font, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, Spain
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Ray P, Black S, Shinefield H, Dillon A, Carpenter D, Lewis E, Ross P, Chen RT, Klein NP, Baxter R. Risk of rheumatoid arthritis following vaccination with tetanus, influenza and hepatitis B vaccines among persons 15-59 years of age. Vaccine 2011; 29:6592-7. [PMID: 21763385 DOI: 10.1016/j.vaccine.2011.06.112] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 06/27/2011] [Accepted: 06/29/2011] [Indexed: 11/17/2022]
Abstract
BACKGROUND Associations between vaccinations, particularly hepatitis B, and onset of rheumatoid arthritis (RA) have been reported, but examined in few large-scale studies. METHOD Onset of RA cases and dates of vaccination against hepatitis B, tetanus, and influenza were identified in a retrospective chart review of approximately 1 million Kaiser Permanente Northern California members ages 15-59 years from 1997 through 1999. In a cohort analysis, rates of new-onset RA were compared between vaccinated and unvaccinated within 90, 180, and 365 days. In a case-control analysis, rates of vaccination during exposure intervals (90, 180, 365, and 730 days) were compared between cases and controls using conditional logistic regression. RESULTS 378 RA cases were included in the cohort analysis; 37 additional cases were included in the case-control analysis. In the cohort analysis the relative risks of RA onset within 90, 180, or 365 days of hepatitis B vaccination were not significant (R.R.=1.44, p=0.53; R.R.=1.67, p=0.22; R.R.=1.23, p=0.59 respectively). We found a possible association between RA and influenza vaccine in the previous 180 and 365 days in the cohort analysis (R.R=1.36, p=0.03; R.R.=1.34, p=0.01 respectively), but in the case-control analysis, cases were no more likely than controls to have received any of the three vaccines. CONCLUSIONS In this large retrospective study we found no statistically significant association between exposure to hepatitis B vaccine and onset of RA. A possible association between RA and influenza vaccination in the cohort study was not borne out in the larger case-control analysis.
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Affiliation(s)
- Paula Ray
- Kaiser Permanente Vaccine Study Center, Oakland, CA, USA
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11
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Dell' Era L, Esposito S, Corona F, Principi N. Vaccination of children and adolescents with rheumatic diseases. Rheumatology (Oxford) 2011; 50:1358-65. [PMID: 21482543 DOI: 10.1093/rheumatology/ker102] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Children with rheumatic diseases (RDs) are at greater risk of infection because of their aberrant immunity and frequent use of immunosuppressive drugs. However, the use of vaccinations in such children is debated by many experts who think that the patients' immune response is insufficient to assure protection; some of them are also afraid that vaccines could trigger a persistent autoimmune response and lead to severe clinical problems including a relapse of the RD. This review describes the available data regarding the risks of vaccine administration, and the immunogenicity, efficacy and tolerability of the vaccines usually recommended for children with RDs. The data not only show that the schedule suggested for otherwise healthy children should be followed, but also that pneumococcal and influenza vaccinations should be strongly recommended because of the known risk of severe infections in patients with RD. However, there are areas in which further research is urgently required.
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Affiliation(s)
- Laura Dell' Era
- Department of Maternal and Pediatric Sciences, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122 Milano, Italy
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12
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Kang JH, Lin HC. Comorbidities in patients with primary Sjogren's syndrome: a registry-based case-control study. J Rheumatol 2010; 37:1188-94. [PMID: 20360180 DOI: 10.3899/jrheum.090942] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Although multiple diseases associated with primary Sjögren's syndrome (pSS) have been reported, reliable data regarding the prevalence of specific medical comorbidities among patients with pSS remain sparse. We investigated the prevalence and risk for a broad spectrum of medical conditions among patients with pSS in Taiwan. METHODS A total of 1974 patients with pSS were eligible for inclusion in the study group. We randomly selected 9870 enrollees matched with the study subjects, using the Taiwan National Health Insurance Research Dataset for 2006 and 2007, inclusive. Conditional logistic regression analyses conditioned on sex, age, monthly income, and level of urbanization of the patient's community were used to calculate the odds ratios (OR) of various comorbid conditions. RESULTS Pearson chi-square tests revealed that patients with pSS had significantly higher prevalence of hyperlipidemia, cardiac arrhythmias, headaches, migraines, fibromyalgia (FM), asthma, pulmonary circulation disorders, hypothyroidism, liver disease, peptic ulcers, hepatitis B, deficiency anemias, depression, and psychoses. Conditional regression analyses showed that, compared to patients without the condition, patients with pSS were more likely to have hyperlipidemia (OR 1.42), cardiac arrhythmias (OR 1.32), headaches (OR 1.47), migraines (OR 1.86), FM (OR 1.71), asthma (OR 1.54), pulmonary circulation disorders (OR 1.42), hypothyroidism (OR 2.37), liver disease (OR 1.89), peptic ulcers (OR 1.88), hepatitis B (OR 2.34), deficiency anemias (OR 1.33), depression (OR 2.57), and psychoses (OR 2.15). CONCLUSION The prevalence of several comorbidities was increased among the patients with pSS. Our study provides epidemiological data for comorbidities among pSS patients in an ethnic Chinese population.
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Affiliation(s)
- Jiunn-Horng Kang
- Department of Physical Medicine and Rehabilitation and Neuroscience Research Center, Taipei, Taiwan
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13
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Chronic hepatitis B virus infection in Sjögren's syndrome. Prevalence and clinical significance in 603 patients. Autoimmun Rev 2009; 8:616-20. [DOI: 10.1016/j.autrev.2009.02.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Accepted: 02/05/2009] [Indexed: 12/21/2022]
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Ramos-Casals M, Brito-Zerón P, Font J. Lessons from diseases mimicking Sjögren's syndrome. Clin Rev Allergy Immunol 2008; 32:275-83. [PMID: 17992594 DOI: 10.1007/s12016-007-8006-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Sjögren's syndrome (SS) is a systemic autoimmune disease that mainly affects the exocrine glands and usually presents as persistent dryness of the mouth and eyes because of functional impairment of the salivary and lacrimal glands. The histological hallmark is a focal lymphocytic infiltration of the exocrine glands, and the spectrum of the disease extends from an organ-specific autoimmune disease (autoimmune exocrinopathy) to a systemic process with diverse extraglandular manifestations. In the absence of an associated systemic autoimmune disease, patients with this condition are classified as having primary SS. The differential diagnosis includes processes that specifically involve the exocrine glands. On the one hand, some chronic viral infections may induce lymphocytic infiltration of the exocrine glands, in some cases indistinguishable from that observed in primary SS. On the other hand, some processes may mimic the clinical picture of SS through nonlymphocytic infiltration of the exocrine glands. This review focuses on these two groups of diseases that mimic SS (infections and infiltrating processes).
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Affiliation(s)
- Manuel Ramos-Casals
- Servei de Malalties Autoimmunes, Hospital Clínic, C/Villarroel, 170, 08036 Barcelona, Spain.
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15
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Mor A, Pillinger MH, Wortmann RL, Mitnick HJ. Drug-induced arthritic and connective tissue disorders. Semin Arthritis Rheum 2007; 38:249-64. [PMID: 18166218 DOI: 10.1016/j.semarthrit.2007.10.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2007] [Revised: 10/01/2007] [Accepted: 10/21/2007] [Indexed: 12/15/2022]
Abstract
OBJECTIVES All pharmacologic agents have the potential for both benefit and toxicity. Among the more interesting and important adverse consequences of drug therapy are a range of joint and connective tissue complaints that may mimic or reproduce primary rheumatologic diseases. In this article, we review the literature on commonly used drugs reported to induce arthritis and/or connective tissue-based diseases. We assess the strength of the reported associations, discuss diagnostic features and treatment implications, and consider possible mechanisms for drug-induced genesis of rheumatic conditions. METHODS We reviewed the Medline database from 1987 to 2006 to identify drug-induced arthritic and connective-tissue disease syndromes, utilizing 48 search terms. A qualitative review was performed after the articles were abstracted and the relevant information was organized. RESULTS Three hundred fifty-seven articles of possible relevance were identified. Two hundred eleven publications were included in the final analysis (case series and reports, clinical trials, and reviews). Many drugs were identified as mimicking existing rheumatic conditions, including both well-established small molecules (eg, sulfasalazine) and recently introduced biologic agents (eg, antitumor necrosis factor agents). The most commonly reported drug-induced rheumatic conditions were lupus-like syndromes. Arthritis and vasculitis were also often reported. CONCLUSIONS Drug-induced rheumatic syndromes are manifold and offer the clinician an opportunity to define an illness that may remit with discontinuation of the offending agent. Early diagnosis and withdrawal of the drug may prevent unnecessary morbidity and disability.
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Affiliation(s)
- Adam Mor
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY 10003, USA.
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Turkcapar N, Kinikli G, Sak SD, Duman M. Specific immunotherapy-induced Sjögren's syndrome. Rheumatol Int 2005; 26:182-4. [PMID: 15965636 DOI: 10.1007/s00296-005-0606-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2004] [Accepted: 01/31/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Allergen-specific immunotherapy (SIT) is a well-documented treatment for allergic rhinitis, asthma, and allergy to bee venoms. Side-effects of SIT in long-term have not been well documented yet. Herein, we report a case of Sjögren's syndrome following SIT. CASE The patient, a 25-year-old Caucasian woman, was started on subcutaneous grass-pollen immunotherapy. The patient's autoantibodies before the SIT screening tests were negative. We determined that anti-extractable nuclear antigen (ENA) was positive (ENA = 98.4, normal range 0-25 U) on routine screening tests at 44 weeks of her treatment, and then SIT was discontinued. The patient complained of burning and itching in her eyes for 6 months. Schirmer's and salivary flow tests were positive. Although antinuclear antigen and rheumatoid factor were negative, anti-SS-A/Ro was positive. Viral hepatitis markers were negative. Minor salivary-gland biopsy was performed, which showed grade 4 sialoadenitis. The HLA type of the patient was B55 (B22), Bw6, Cw1 for class I and DR11, DR52, DQ7 (DQ3) for class II. After the immunotherapy had been stopped, there were no changes in the symptoms and laboratory findings of the patient during the 1st year of follow-up. CONCLUSION This is the first case to be reported of Sjögren's syndrome following SIT. Patients undergoing SIT must be carefully followed up for the development of autoimmunity and an autoimmune disease.
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Affiliation(s)
- N Turkcapar
- Department of Clinical Immunology and Rheumatology, School of Medicine, Ankara University, 4. Sok. 22/50 Manolya Apt. Sogutozu, Sihhiye, 06590 Ankara, Turkey.
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Schattner A. Consequence or coincidence? The occurrence, pathogenesis and significance of autoimmune manifestations after viral vaccines. Vaccine 2005; 23:3876-86. [PMID: 15917108 DOI: 10.1016/j.vaccine.2005.03.005] [Citation(s) in RCA: 132] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2004] [Revised: 02/02/2005] [Accepted: 03/04/2005] [Indexed: 12/27/2022]
Abstract
BACKGROUND Viruses and virus-induced lymphokines may have an important role in the pathogenesis of autoimmunity (Schattner A. Clin Immunol Immunopathol; 1994). The occurrence and significance of autoimmune manifestations after the administration of viral vaccines remain controversial. METHODS Medline search of all relevant publications from 1966 through June 2004 with special emphasis on search of each individual autoimmune manifestation and vaccination, as well as specifically searching each viral vaccine for all potential autoimmune syndromes reported. All relevant publications were retrieved and critically analyzed. RESULTS The most frequently reported autoimmune manifestations for the various vaccinations, were: hepatitis A virus (HAV)--none; hepatitis B virus (HBV)--rheumatoid arthritis, reactive arthritis, vasculitis, encephalitis, neuropathy, thrombocytopenia; measles, mumps and rubella vaccine (MMR)--acute arthritis or arthralgia, chronic arthritis, thrombocytopenia; influenza--Guillain-Barre syndrome (GBS), vasculitis; polio--GBS; varicella--mainly neurological syndromes. Even these 'frequent' associations relate to a relatively small number of patients. Whenever controlled studies of autoimmunity following viral vaccines were undertaken, no evidence of an association was found. CONCLUSIONS Very few patients may develop some autoimmune diseases following viral vaccination (in particular - arthropathy, vasculitis, neurological dysfunction and thrombocytopenia). For the overwhelming majority of people, vaccines are safe and no evidence linking viral vaccines with type 1 diabetes, multiple sclerosis (MS) or inflammatory bowel disease can be found.
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Affiliation(s)
- Ami Schattner
- Department of Medicine, University of Cambridge, School of Clinical Medicine, Level 5, Addenbrooke's Hospital, Hills Road, Cambridge CB2 2QQ, UK.
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