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Min HK, Kim SH, Lee SH, Kim HR. Recent advances in the diagnosis and management of interstitial pneumonia with autoimmune features: the perspective of rheumatologists. Korean J Intern Med 2021; 36:515-526. [PMID: 33045807 PMCID: PMC8137388 DOI: 10.3904/kjim.2020.443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 10/07/2020] [Indexed: 12/29/2022] Open
Abstract
Interstitial pneumonia with autoimmune feature (IPAF) is a recently established disease entity that is comprised of interstitial lung diseases with evidence of autoimmune features but that does not fulfill the criteria for definite autoimmune rheumatic diseases. The classification criteria for IPAF were defined by the European Respiratory Society and American Thoracic Society in 2015. However, further studies to establish IPAF subgroups and treatment modalities for each subgroup are still needed. In this review, we discuss recent advances regarding IPAF and raise critical points for the diagnosis and management of patients with IPAF from the perspective of rheumatologists.
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Affiliation(s)
- Hong Ki Min
- Division of Rheumatology, Department of Internal Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Se-Hee Kim
- Division of Rheumatology, Department of Internal Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Sang-Heon Lee
- Division of Rheumatology, Department of Internal Medicine, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea
| | - Hae-Rim Kim
- Division of Rheumatology, Department of Internal Medicine, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea
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Huang CC, Ho CH, Chen YC, Hsu CC, Lin HJ, Wang JJ, Guo HR. Autoimmune Connective Tissue Disease Following Carbon Monoxide Poisoning: A Nationwide Population-Based Cohort Study. Clin Epidemiol 2020; 12:1287-1298. [PMID: 33262659 PMCID: PMC7686473 DOI: 10.2147/clep.s266396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 11/03/2020] [Indexed: 11/23/2022] Open
Abstract
Background In addition to hypoxia, oxidative stress and inflammation due to carbon monoxide (CO) poisoning cause adverse health effects. These mechanisms are related to the occurrence of autoimmune connective tissue disease, but studies on the association between CO poisoning and autoimmune connective tissue disease are limited. We conducted a study to evaluate the occurrence of autoimmune connective tissue disease following CO poisoning. Methods We identified participants with CO poisoning diagnosed between 1999 and 2012 from the Nationwide Poisoning Database and selected participants without CO poisoning from the Taiwan National Health Insurance Research Database with matching age and index dates at a 1:3 ratio. Sex, underlying comorbidities, and monthly income were also included in the analyses. We followed up the participants until 2013 and made comparison of the risk of autoimmune connective tissue disease between participants with and without CO poisoning. Results The 23,877 participants with CO poisoning had a higher risk for autoimmune connective tissue disease than the 71,631 participants without CO poisoning (adjusted hazard ratio [AHR], 3.5; 95% confidence interval [CI], 3.1–3.9) after adjustment for sex, diabetes, Lyme disease, herpes zoster, infectious mononucleosis, hepatitis, HIV infection, liver disease, renal disease, non-CO poisoning or drug abuse, malignancy, hypertension, hyperlipidemia, coronary artery disease, congestive heart failure, chronic obstructive pulmonary disease, and monthly income. An increased risk was observed even after 4 years of follow-up (AHR, 3.6; 95% CI, 3.0–4.4). Conclusion The risk of autoimmune connective tissue disease increased following CO poisoning. Close follow-up of the patients with CO poisoning for the development of connective tissue disease is recommended, and further investigation of the detailed mechanisms is warranted.
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Affiliation(s)
- Chien-Cheng Huang
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan.,Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Senior Services, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan.,Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Yi-Chen Chen
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Chien-Chin Hsu
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan.,Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Hung-Jung Lin
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan.,Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan.,Allied AI Biomed Center, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - How-Ran Guo
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.,Occupational Safety, Health and Medicine Research Center, National Cheng Kung University Hospital, Tainan, Taiwan
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Mofors J, Björk A, Richardsdotter Andersson E, Kvarnström M, Forsblad d'Elia H, Magnusson-Bucher S, Padyukov L, Kockum I, Hillert J, Eriksson P, Mandl T, Nordmark G, Alfredsson L, Wahren-Herlenius M. Cigarette smoking patterns preceding primary Sjögren's syndrome. RMD Open 2020; 6:rmdopen-2020-001402. [PMID: 32994363 PMCID: PMC7547543 DOI: 10.1136/rmdopen-2020-001402] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/20/2020] [Accepted: 09/09/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Cigarette smoking is a well-established risk factor for several autoimmune diseases, but its role in primary Sjögren's syndrome (pSS) remains unclear. Here, we investigated the association between cigarette smoking and subsequent development of pSS. METHODS Information on smoking habits was collected from lifestyle habit questionnaires of patients with pSS (n=815) and a matched control group (n=4425) for a case-control study. Differences in smoking exposure were analysed by conditional logistic regression. Potential interactions between smoking and risk-associated human leucocyte antigens (HLA) were assessed by multivariate regression. RESULTS The fraction of patients with pSS having ever smoked prior to diagnosis was lower than in controls (OR 0.67, 95% CI 0.55 to 0.81). Current smoking at diagnosis was also less prevalent in cases (OR 0.37, 95% CI 0.26 to 0.53). However, period prevalence of smoking during early adulthood was not statistically different from controls (OR 0.89, 95% CI 0.66 to 1.22) but markedly decreased over time. This was partly due to patients being more prone to stop smoking, starting already 30 years prior to diagnosis (OR 2.01, 95% CI 1.22 to 3.30). Smoking patterns were also stratified by autoantibody status, yielding similar estimates. No interaction effects between HLA-DRB1 haplotypes and smoking were observed. CONCLUSION The observed smoking patterns indicate that individuals who develop pSS smoke equally much as the general population during early life but are then more prone to stop. The data can be interpreted as smoking conferring protective effects, or reflecting early symptoms of pSS that affect smoking habits, emphasising the slow, progressive development of the disease.
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Affiliation(s)
- Johannes Mofors
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Albin Björk
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Elina Richardsdotter Andersson
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Marika Kvarnström
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Helena Forsblad d'Elia
- Department of Public Health and Clinical Medicine, Rheumatology, Umeå University, Umeå, Sweden
| | - Sara Magnusson-Bucher
- Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Leonid Padyukov
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Ingrid Kockum
- Department of Clinical Neuroscience, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Per Eriksson
- Division of Rheumatology, Department of Clinical Experimental Medicine, Linköping University, Linköping, Sweden
| | - Thomas Mandl
- Department of Clinical Sciences, Malmö, Rheumatology, Lund University, Malmö, Sweden
| | - Gunnel Nordmark
- Department of Medical Sciences, Rheumatology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Lars Alfredsson
- Department of Clinical Neuroscience, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Marie Wahren-Herlenius
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden .,Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
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4
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Servioli L, Maciel G, Nannini C, Crowson CS, Matteson EL, Cornec D, Berti A. Association of Smoking and Obesity on the Risk of Developing Primary Sjögren Syndrome: A Population-based Cohort Study. J Rheumatol 2019; 46:727-730. [PMID: 30647188 DOI: 10.3899/jrheum.180481] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To explore the role of smoking and obesity in primary Sjögren syndrome (pSS). METHODS Olmsted County (Minnesota, USA) residents (n = 106) diagnosed with pSS from 2000 to 2015 were compared to 3 controls without pSS and matched for age and sex who were randomly selected from Olmsted County residents. RESULTS Current smokers were less likely to be pSS cases (OR 0.34, 95% CI 0.14-0.85), while there was no association between former smoking and case/control status (OR 1.27, 95% CI 0.80-2.03) compared to never smokers. Smoking status was not associated with antinuclear antibody, anti-SSA, anti-SSB, or rheumatoid factor positivity (p > 0.05). OR for obesity was 0.79 (95% CI 0.48-1.30). CONCLUSION In this population-based study, current smoking was inversely associated with case/control status, while body mass index lacked any association.
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Affiliation(s)
- Luisa Servioli
- From the Division of Rheumatology, and Division of Biomedical Statistics and Informatics, and Division of Epidemiology, and Division of Pulmonary and Critical Care Medicine, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel, Montevideo, Uruguay; Department of Rheumatology, Hospital of Prato, Prato, Italy; Rheumatology Department, Brest Teaching Hospital, Brest, France; Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, Milan, Italy; Rheumatology Department, Santa Chiara Hospital, Trento, Italy.,L. Servioli, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Autoimmune diseases Department, Medical Clinic 1, Hospital Maciel; G. Maciel, MD, Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel; C. Nannini, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Department of Rheumatology, Hospital of Prato; C.S. Crowson, PhD, Division of Rheumatology, and Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; E.L. Matteson, MD, MPH, Division of Rheumatology, and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; D. Cornec, MD, PhD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and Rheumatology Department, Brest Teaching Hospital; A. Berti, MD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and the Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, and the Rheumatology Department, Santa Chiara Hospital
| | - Gabriel Maciel
- From the Division of Rheumatology, and Division of Biomedical Statistics and Informatics, and Division of Epidemiology, and Division of Pulmonary and Critical Care Medicine, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel, Montevideo, Uruguay; Department of Rheumatology, Hospital of Prato, Prato, Italy; Rheumatology Department, Brest Teaching Hospital, Brest, France; Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, Milan, Italy; Rheumatology Department, Santa Chiara Hospital, Trento, Italy.,L. Servioli, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Autoimmune diseases Department, Medical Clinic 1, Hospital Maciel; G. Maciel, MD, Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel; C. Nannini, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Department of Rheumatology, Hospital of Prato; C.S. Crowson, PhD, Division of Rheumatology, and Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; E.L. Matteson, MD, MPH, Division of Rheumatology, and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; D. Cornec, MD, PhD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and Rheumatology Department, Brest Teaching Hospital; A. Berti, MD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and the Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, and the Rheumatology Department, Santa Chiara Hospital
| | - Carlotta Nannini
- From the Division of Rheumatology, and Division of Biomedical Statistics and Informatics, and Division of Epidemiology, and Division of Pulmonary and Critical Care Medicine, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel, Montevideo, Uruguay; Department of Rheumatology, Hospital of Prato, Prato, Italy; Rheumatology Department, Brest Teaching Hospital, Brest, France; Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, Milan, Italy; Rheumatology Department, Santa Chiara Hospital, Trento, Italy.,L. Servioli, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Autoimmune diseases Department, Medical Clinic 1, Hospital Maciel; G. Maciel, MD, Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel; C. Nannini, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Department of Rheumatology, Hospital of Prato; C.S. Crowson, PhD, Division of Rheumatology, and Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; E.L. Matteson, MD, MPH, Division of Rheumatology, and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; D. Cornec, MD, PhD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and Rheumatology Department, Brest Teaching Hospital; A. Berti, MD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and the Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, and the Rheumatology Department, Santa Chiara Hospital
| | - Cynthia S Crowson
- From the Division of Rheumatology, and Division of Biomedical Statistics and Informatics, and Division of Epidemiology, and Division of Pulmonary and Critical Care Medicine, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel, Montevideo, Uruguay; Department of Rheumatology, Hospital of Prato, Prato, Italy; Rheumatology Department, Brest Teaching Hospital, Brest, France; Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, Milan, Italy; Rheumatology Department, Santa Chiara Hospital, Trento, Italy.,L. Servioli, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Autoimmune diseases Department, Medical Clinic 1, Hospital Maciel; G. Maciel, MD, Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel; C. Nannini, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Department of Rheumatology, Hospital of Prato; C.S. Crowson, PhD, Division of Rheumatology, and Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; E.L. Matteson, MD, MPH, Division of Rheumatology, and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; D. Cornec, MD, PhD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and Rheumatology Department, Brest Teaching Hospital; A. Berti, MD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and the Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, and the Rheumatology Department, Santa Chiara Hospital
| | - Eric L Matteson
- From the Division of Rheumatology, and Division of Biomedical Statistics and Informatics, and Division of Epidemiology, and Division of Pulmonary and Critical Care Medicine, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel, Montevideo, Uruguay; Department of Rheumatology, Hospital of Prato, Prato, Italy; Rheumatology Department, Brest Teaching Hospital, Brest, France; Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, Milan, Italy; Rheumatology Department, Santa Chiara Hospital, Trento, Italy. .,L. Servioli, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Autoimmune diseases Department, Medical Clinic 1, Hospital Maciel; G. Maciel, MD, Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel; C. Nannini, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Department of Rheumatology, Hospital of Prato; C.S. Crowson, PhD, Division of Rheumatology, and Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; E.L. Matteson, MD, MPH, Division of Rheumatology, and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; D. Cornec, MD, PhD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and Rheumatology Department, Brest Teaching Hospital; A. Berti, MD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and the Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, and the Rheumatology Department, Santa Chiara Hospital.
| | - Divi Cornec
- From the Division of Rheumatology, and Division of Biomedical Statistics and Informatics, and Division of Epidemiology, and Division of Pulmonary and Critical Care Medicine, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel, Montevideo, Uruguay; Department of Rheumatology, Hospital of Prato, Prato, Italy; Rheumatology Department, Brest Teaching Hospital, Brest, France; Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, Milan, Italy; Rheumatology Department, Santa Chiara Hospital, Trento, Italy.,L. Servioli, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Autoimmune diseases Department, Medical Clinic 1, Hospital Maciel; G. Maciel, MD, Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel; C. Nannini, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Department of Rheumatology, Hospital of Prato; C.S. Crowson, PhD, Division of Rheumatology, and Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; E.L. Matteson, MD, MPH, Division of Rheumatology, and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; D. Cornec, MD, PhD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and Rheumatology Department, Brest Teaching Hospital; A. Berti, MD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and the Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, and the Rheumatology Department, Santa Chiara Hospital
| | - Alvise Berti
- From the Division of Rheumatology, and Division of Biomedical Statistics and Informatics, and Division of Epidemiology, and Division of Pulmonary and Critical Care Medicine, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel, Montevideo, Uruguay; Department of Rheumatology, Hospital of Prato, Prato, Italy; Rheumatology Department, Brest Teaching Hospital, Brest, France; Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, Milan, Italy; Rheumatology Department, Santa Chiara Hospital, Trento, Italy.,L. Servioli, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Autoimmune diseases Department, Medical Clinic 1, Hospital Maciel; G. Maciel, MD, Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel; C. Nannini, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Department of Rheumatology, Hospital of Prato; C.S. Crowson, PhD, Division of Rheumatology, and Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; E.L. Matteson, MD, MPH, Division of Rheumatology, and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; D. Cornec, MD, PhD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and Rheumatology Department, Brest Teaching Hospital; A. Berti, MD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and the Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, and the Rheumatology Department, Santa Chiara Hospital
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Olsson P, Skogstrand K, Nilsson A, Turesson C, Jacobsson LTH, Theander E, Houen G, Mandl T. Smoking, disease characteristics and serum cytokine levels in patients with primary Sjögren's syndrome. Rheumatol Int 2018; 38:1503-1510. [PMID: 29846789 PMCID: PMC6060795 DOI: 10.1007/s00296-018-4063-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 05/23/2018] [Indexed: 01/21/2023]
Abstract
Smoking affects several disease processes. Epidemiological studies have previously found a negative association between primary Sjögren’s syndrome (pSS) and smoking. The aim of this study was to examine whether markers of disease activity and cytokine expression in pSS patients differ between ever and never smokers. Fifty-one consecutive pSS patients and 33 population controls were included in the study. Clinical and standard laboratory parameters were registered. Serum cytokines (IL-1β, IL-2, IL-3, IL-4, IL-6, IL-8, IL-10, IL-12, IL-17, IL-18, IL-33, IFN-α, IFN-γ, TNF-α, EGF, BAFF, Fas-ligand, RANTES, TGF-β1) were assessed. A positive lip biopsy was less prevalent among ever smoking patients compared to never smokers (81 vs 100%; p = 0.03). However, except for TNF-α, which was higher in ever smokers, no differences in cytokine levels were found when comparing ever and never smoking pSS patients. Furthermore, no significant differences were found between ever and never smoking patients in the ESSDAI total score, IgG levels, or complement levels. However, IL-6, IL-12, IL-17 and IL-18 were significantly increased in pSS patients compared to controls. In this study, a negative association between ever smoking and positive lip biopsy was found, confirming previous reports. Expected differences in cytokine levels compared to controls were noted, but no major differences were found between ever and never smoking pSS patients. Taking into account the negative association between pSS diagnosis and smoking in epidemiological studies, possible explanations include a local effect of smoking on salivary glands rather than systemic effects by cigarette smoke.
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Affiliation(s)
- Peter Olsson
- Department of Clinical Sciences, Malmö, Rheumatology, Lund University, Malmö, Sweden. .,Department of Rheumatology, Skåne University Hospital, Malmö, Sweden. .,Reumatologmottagningen SUS Malmö, Jan Waldenströms gata 1B, 20502, Malmö, Sweden.
| | - Kristin Skogstrand
- Department of Congenital Disorders, Center for Neonatal Screening, Statens Serum Institut, Copenhagen, Denmark
| | - Anna Nilsson
- Department of Clinical Sciences, Malmö, Rheumatology, Lund University, Malmö, Sweden.,Department of Rheumatology, Linköping University Hospital, Linköping, Sweden
| | - Carl Turesson
- Department of Clinical Sciences, Malmö, Rheumatology, Lund University, Malmö, Sweden.,Department of Rheumatology, Skåne University Hospital, Malmö, Sweden
| | - Lennart T H Jacobsson
- Department of Clinical Sciences, Malmö, Rheumatology, Lund University, Malmö, Sweden.,Department of Rheumatology and Inflammation Research, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Elke Theander
- Department of Clinical Sciences, Malmö, Rheumatology, Lund University, Malmö, Sweden.,Janssen Cilag, Solna, Sweden
| | - Gunnar Houen
- Department of Autoimmunology and Biomarkers, Statens Serum Institut, Copenhagen, Denmark
| | - Thomas Mandl
- Department of Clinical Sciences, Malmö, Rheumatology, Lund University, Malmö, Sweden.,Department of Rheumatology, Skåne University Hospital, Malmö, Sweden
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6
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Hammam N, Gheita TA. Impact of secondhand smoking on disease activity in women with rheumatoid arthritis. Clin Rheumatol 2017; 36:2415-2420. [PMID: 28842759 DOI: 10.1007/s10067-017-3795-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 08/08/2017] [Accepted: 08/15/2017] [Indexed: 12/23/2022]
Abstract
Smoking is an established risk factor for the development and severity of rheumatoid arthritis (RA) with prominent production of cytokines. The aim of the work was to study the possible effect of secondhand exposure on disease activity in non-smoking female RA patients. This cross-sectional study include 100 women with RA attending the rheumatology outpatient clinic and were grouped according to the non-smoking status into those not exposed to smoking and those considered secondhand smokers (SHS). Disease activity score in 28 joints (DAS28) was calculated and the patients' global assessment (PGA) score were assessed. The mean age of the patients was 45.2 ± 12.1 years and disease duration was 8.3 ± 6 years. Their DAS28 score was 4.3 ± 0.93 with a PGA score of 1.47 ± 1.36. Forty-seven of the patients were SHS and 53 were non-exposed. The secondhand smokers were significantly younger (41.6 ± 11.7 years) than the non-smokers (48.3 ± 11.6 years) (p = 0.005), and the DAS28 was significantly higher (4.6 ± 0.84 versus 4.1 ± 0.97; p = 0.02) compared to non-smokers. The disease duration and medications received were comparable. There is evidence pointing to the important role of secondhand smoking on disease activity in RA female patients. Studying the effect of secondhand smoking in view of the cytokine milieu could help confirm the relation to the disease pathogenesis. Taking into consideration the risk of cardiovascular disease and interplay with other potential factors should be well thought of. It is essential to draw patients' attention to the expected hazardous effect of passive smoking.
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Affiliation(s)
- Nevin Hammam
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Assiut University, Asyut, Egypt. .,Faculty of Rehabilitation, University of Alberta, Edmonton, Alberta, Canada.
| | - Tamer A Gheita
- Rheumatology and Clinical Immunology Department, Faculty of Medicine, Cairo University, Giza, Egypt
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7
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Olsson P, Turesson C, Mandl T, Jacobsson L, Theander E. Cigarette smoking and the risk of primary Sjögren's syndrome: a nested case control study. Arthritis Res Ther 2017; 19:50. [PMID: 28270185 PMCID: PMC5341180 DOI: 10.1186/s13075-017-1255-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 02/09/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Smoking is reported to affect the risk of a number of chronic disorders, including rheumatic diseases. Previous cross-sectional studies have shown a lower frequency of smoking in patients with primary Sjögren's syndrome (pSS). The aim of this study was to investigate the impact of smoking and socioeconomic status on the risk of subsequent diagnosis of pSS in a nested case-control study. METHOD Participants in two large population-based health surveys who were later diagnosed with pSS were identified through linkage with the Malmö Sjögren's Syndrome Register. Matched controls were obtained from the health surveys. RESULTS Sixty-three patients with pSS with pre-diagnostic data from the health surveys were identified. Current smoking was associated with a significantly lower risk of later being diagnosed with pSS (odds ratio (OR) 0.3; 95% CI 0.1-0.6). Furthermore, former smoking was associated with an increased risk of subsequent pSS diagnosis (OR 4.0; 95% CI 1.8-8.8) compared to never smoking. Similar results were found in a sub-analysis of patients with reported symptom onset after inclusion in the health surveys. Socioeconomic status and levels of formal education had no significant impact on the risk of later being diagnosed with pSS. CONCLUSION In this nested case-control study, current smoking was associated with a reduced risk of subsequent diagnosis of pSS. In addition, former smoking was associated with an increased risk. Whether this reflects a biological effect of cigarette smoking or other mechanisms should be further investigated in future studies.
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Affiliation(s)
- Peter Olsson
- Department of Clinical sciences, Malmö, Rheumatology, Lund University, Malmö, Sweden. .,Department of Rheumatology, Skåne University Hospital, Lund University, Inga Marie Nilssons gata 32, 20502, Malmö, Sweden.
| | - Carl Turesson
- Department of Clinical sciences, Malmö, Rheumatology, Lund University, Malmö, Sweden.,Department of Rheumatology, Skåne University Hospital, Lund University, Inga Marie Nilssons gata 32, 20502, Malmö, Sweden
| | - Thomas Mandl
- Department of Clinical sciences, Malmö, Rheumatology, Lund University, Malmö, Sweden.,Department of Rheumatology, Skåne University Hospital, Lund University, Inga Marie Nilssons gata 32, 20502, Malmö, Sweden
| | - Lennart Jacobsson
- Department of Clinical sciences, Malmö, Rheumatology, Lund University, Malmö, Sweden.,Department of Rheumatology and Inflammation research, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Elke Theander
- Department of Clinical sciences, Malmö, Rheumatology, Lund University, Malmö, Sweden.,Department of Rheumatology, Skåne University Hospital, Lund University, Inga Marie Nilssons gata 32, 20502, Malmö, Sweden
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Effect of Tobacco Smoking on The Clinical, Histopathological, and Serological Manifestations of Sjögren's Syndrome. PLoS One 2017; 12:e0170249. [PMID: 28166540 PMCID: PMC5293551 DOI: 10.1371/journal.pone.0170249] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 12/31/2016] [Indexed: 01/11/2023] Open
Abstract
Objectives To assess the association of smoking habits with the clinical, serological, and histopathological manifestations of Sjögren’s syndrome (SS) and non-Sjögren’s sicca (non-SS sicca). Methods Cross-sectional case-control study of 1288 patients with sicca symptoms (587 SS and 701 non-SS sicca) evaluated in a multi-disciplinary research clinic. Smoking patterns were obtained from questionnaire data and disease-related clinical and laboratory data were compared between current, past, ever, and never smokers. Results Current smoking rates were 4.6% for SS patients compared to 14.1% in non-SS sicca (p = 5.17x10E-09), 18% in a local lupus cohort (p = 1.13x10E-14) and 16.8% in the community (p = 4.12x10E-15). Current smoking was protective against SS classification (OR 0.35, 95%CI 0.22–0.56, FDR q = 1.9E10-05), focal lymphocytic sialadenitis (OR 0.26, 95%CI 0.15–0.44, FDR q = 1.52x10E-06), focus score ≥1 (OR 0.22, 95%CI 0.13–0.39, FDR q = 1.43x10E-07), and anti-Ro/SSA(+) (OR 0.36, 95%CI 0.2–0.64, FDR q = 0.0009); ever smoking was protective against the same features and against anti-La/SSB(+) (OR 0.52, 95%CI 0.39–0.70, FDR q = 5.82x10E-05). Duration of smoking was inversely correlated with SS even after controlling for socioeconomic status, BMI, alcohol and caffeine consumption. Conclusions Current tobacco smoking is negatively and independently associated with SS, protecting against disease-associated humoral and cellular autoimmunity. The overall smoking rate amongst SS patients is significantly lower than in matched populations and the effects of smoking are proportional to exposure duration. In spite of the protective effects of tobacco on SS manifestations, it is associated with other serious comorbidities such as lung disease, cardiovascular risk and malignancy, and should thus be strongly discouraged in patients with sicca.
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Shen TC, Chen HJ, Wei CC, Chen CH, Tu CY, Hsia TC, Shih CM, Hsu WH, Sung FC, Bau DT. Risk of asthma in patients with primary Sjögren's syndrome: a retrospective cohort study. BMC Pulm Med 2016; 16:152. [PMID: 27852248 PMCID: PMC5112692 DOI: 10.1186/s12890-016-0312-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 11/07/2016] [Indexed: 11/25/2022] Open
Abstract
Background Sjögren’s syndrome (SS) has been associated with bronchial hyperresponsiveness and asthma; however, no population-based cohort study has been performed. We evaluated the risk of asthma in patients with primary SS in a nationwide population. Methods We conducted a retrospective cohort study using data from the National Health Insurance Research Database in Taiwan. The primary SS group included 4725 adult patients diagnosed between 2000 and 2006. Each patient was frequency-matched with four people without SS by sex, age and year of diagnosis. The occurrence and hazard ratio (HR) of asthma was monitored by the end of 2011. Results The overall incidence density of asthma was 1.62-fold higher in the primary SS group than in the non-SS group (9.86 vs. 6.10 per 1000 person-years), with a multivariable Cox proportional hazards model measured adjusted HR of 1.38 [95% confidence interval (CI) = 1.21–1.58]. Stratified analyses by sex, age group, and presence of comorbidity revealed that asthma incidences were all higher in the primary SS group than in the non-SS group, and the relative HRs of asthma associated with primary SS were significant in all subgroups. Conclusion Patients with primary SS are associated with an increased risk of developing asthma. We should pay more attention to this group of individuals and provide them with appropriate support.
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Affiliation(s)
- Te-Chun Shen
- Graduate Institute of Clinical Medicine Science, College of Medicine, China Medical University, No. 91 Hsueh-Shih Road, Taichung, 404, Taiwan.,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, No. 2 Yu-De Road, Taichung, 404, Taiwan.,Terry Fox Cancer Research Laboratory, Department of Medical Research, China Medical University Hospital, Taichung, 404, Taiwan
| | - Hsuan-Ju Chen
- Management Office for Health Data, China Medical University Hospital, Taichung, 404, Taiwan
| | - Chang-Ching Wei
- Children's Hospital, China Medical University Hospital, Taichung, 404, Taiwan
| | - Chia-Hung Chen
- Graduate Institute of Clinical Medicine Science, College of Medicine, China Medical University, No. 91 Hsueh-Shih Road, Taichung, 404, Taiwan.,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, No. 2 Yu-De Road, Taichung, 404, Taiwan
| | - Chih-Yen Tu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, No. 2 Yu-De Road, Taichung, 404, Taiwan
| | - Te-Chun Hsia
- Graduate Institute of Clinical Medicine Science, College of Medicine, China Medical University, No. 91 Hsueh-Shih Road, Taichung, 404, Taiwan.,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, No. 2 Yu-De Road, Taichung, 404, Taiwan
| | - Chuen-Ming Shih
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, No. 2 Yu-De Road, Taichung, 404, Taiwan
| | - Wu-Huei Hsu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, No. 2 Yu-De Road, Taichung, 404, Taiwan
| | - Fung-Chang Sung
- Management Office for Health Data, China Medical University Hospital, Taichung, 404, Taiwan. .,Department of Health Services Administration, China Medical University, Taichung, 404, Taiwan. .,College of Public Health, Kunming Medical University, No. 1168 Chunrongxi Road, Kunming, 650500, YuanNan, China.
| | - Da-Tian Bau
- Graduate Institute of Clinical Medicine Science, College of Medicine, China Medical University, No. 91 Hsueh-Shih Road, Taichung, 404, Taiwan. .,Terry Fox Cancer Research Laboratory, Department of Medical Research, China Medical University Hospital, Taichung, 404, Taiwan. .,Department of Bioinformatics and Medical Engineering, Asia University, No. 500 Lioufeng Road, Taichung, 41354, Taiwan.
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Shen TC, Wu BR, Chen HJ, Lin CL, Wei CC, Chen CH, Tu CY, Hsia TC, Shih CM, Hsu WH, Sung FC, Kao CH. Risk of Chronic Obstructive Pulmonary Disease in Female Adults With Primary Sjögren Syndrome: A Nationwide Population-Based Cohort Study. Medicine (Baltimore) 2016; 95:e3066. [PMID: 26962839 PMCID: PMC4998920 DOI: 10.1097/md.0000000000003066] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Revised: 02/13/2016] [Accepted: 02/22/2016] [Indexed: 12/13/2022] Open
Abstract
No large-scale population-based cohort study has ever investigated the risk of developing chronic obstructive pulmonary disease (COPD) in patients with Sjögren syndrome (SS). This study evaluated the risk of COPD in women with primary SS (pSS) in a nationwide population.We used the data of the National Health Insurance Research Database of Taiwan to establish a pSS group consisting of 3013 female adults diagnosed between 2000 and 2005, and a non-SS group consisting of 12,052 women without SS matched by a propensity score. Incident COPD cases were identified to the end of 2011. The pSS group to non-SS group adjusted hazard ratios (aHRs) of COPD were estimated using multivariable Cox proportional hazards regression analysis.After a mean follow-up period of 7.99 years, the incidence of COPD was 1.4-fold greater in the pSS group than in the non-SS group (3.87 vs 2.77 per 1000 person-years) with an aHR of 1.39 (95% confidence interval [CI] = 1.10-1.75, P = 0.007). The COPD incidence was 7-fold greater for women aged 50 years and above than women aged 20 to 49, with the aHR of 4.24 (95% CI = 3.06-5.88, P < 0.001). Comorbidity increased the COPD risk further for women with pSS. Women with both pSS and comorbidity had an aHR of 3.11 (95% CI = 2.23-4.33, P < 0.001) for COPD, compared to those free of both pSS and comorbidity.Women with pSS are at a greater risk of developing COPD than those without SS. Patients with SS require close monitoring to prevent COPD development, particularly for those with comorbidity.
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Affiliation(s)
- Te-Chun Shen
- From the Graduate Institute of Clinical Medicine Science (T-CS, C-HC, F-CS, C-HK), College of Medicine; Division of Pulmonary and Critical Care Medicine (T-CS, B-RW, C-HC, C-YT, T-CH, C-MS, W-HH), Department of Internal Medicine; Management Office for Health Data(H-JC, C-LL, F-CS); Children's Hospital (C-CW); Department of Health Services Administration (F-CS), China Medical University, Taichung, Taiwan; Mahidol University Faculty of Public Health, Bangkok (F-CS), Thailand; and Department of Nuclear Medicine and PET Center (C-HK), China Medical University Hospital, Taichung, Taiwan
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Young KA, Terrell DR, Guthridge JM, Kamen DL, Gilkeson GS, Karp DR, Ishimori ML, Weisman MH, Holers VM, Harley JB, Norris JM, James JA. Smoking is not associated with autoantibody production in systemic lupus erythematosus patients, unaffected first-degree relatives, nor healthy controls. Lupus 2014; 23:360-9. [PMID: 24449338 DOI: 10.1177/0961203314520838] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The objective of this paper is to examine whether smoking is associated with autoantibody production in systemic lupus erythematosus (SLE) patients, unaffected first-degree relatives (FDR) of individuals with SLE--a group at increased risk of developing SLE--or unaffected, unrelated controls. METHODS Detailed demographic, environmental, clinical, and therapeutic information was collected by questionnaire on 1242 SLE patients, 981 FDRs, and 946 controls in the Lupus Family Registry and Repository; a blood sample was obtained. All sera were tested for multiple lupus autoantibodies by immunofluorescence and luminex bead-based assays. Generalized estimating equations, adjusting for age, gender, and ethnicity and accounting for correlation within families, were used to assess smoking status with the dichotomous outcome variables of positivity for SLE status, positivity of ANA by immunofluorescence (≥1:120), positivity for ≥1 autoantibody by the luminex assay, and positivity for each of the 11 autoantibodies. RESULTS Current smoking was associated with being positive for ≥1 autoantibody (excluding ANA) (adjusted OR = 1.53, 95% CI 1.04-2.24) in our subjects with SLE. No association was observed in unaffected FDRs or healthy controls. Former smoking was associated with anti-Ro/SS-A60 in our unaffected FDRs. There was an increased association with anti-nRNP A seropositivity, as well as a decreased association with anti-nRNP 68 positivity, in current smokers in SLE subjects. CONCLUSIONS No clear association between smoking status and individual autoantibodies was detected in SLE patients, unaffected FDRs, nor healthy controls within this collection. The association of smoking with SLE may therefore manifest its risk through mechanisms outside of autoantibody production, at least for the specificities tested.
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Affiliation(s)
- K A Young
- 1Department of Epidemiology, Colorado School of Public Health, USA
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12
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Auto-antibodies and their association with clinical findings in women diagnosed with microscopic colitis. PLoS One 2013; 8:e66088. [PMID: 23776613 PMCID: PMC3679050 DOI: 10.1371/journal.pone.0066088] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 05/07/2013] [Indexed: 12/22/2022] Open
Abstract
Background Microscopic colitis (MC) is a disease manifested by diarrhoea and is divided into collagenous and lymphocytic colitis. The aetiology is unknown, but auto-immunity is suggested. Auto-antibodies have been only rarely examined in this entity. The aim of the study was to examine the prevalence of auto-antibodies, and to examine associations between the presence of antibodies and clinical findings. Methods and Findings Women with MC verified by biopsy and younger than 73 years, at any Department of Gastroenterology, in the district of Skåne, between 2002 and 2010 were invited to participate in this study. The patients were asked to complete both a questionnaire describing their medical history and the Gastrointestinal Symptom Rating Scale (GSRS). Blood samples were collected. Anti-nuclear antibodies (ANA), anti-neutrophil cytoplasmic antibodies (ANCA), anti-Saccharomyces cerevisiae antibodies (ASCA), and antibodies against glutamic acid decarboxylase (anti-GAD), islet antigens-like insulin 2 (anti-IA2), thyroid peroxidase (anti-TPO), and thyrotropin receptor (TRAK) were analysed. Of 240 women identified, 133 were finally included in the study, median age 63 (59–67) years. Apart from the MC diagnosis, 52% also suffered from irritable bowel syndrome, 31% from hypertension and 31% from allergy. The prevalence of ANA (14%), ASCA IgG (13%), and anti-TPO antibodies (14%) for these patients was slightly higher than for the general population, and were found together with other concomitant diseases. Patients had more of all gastrointestinal symptoms compared with norm values, irrespective of antibody expression. Conclusions Women with MC have a slightly increased prevalence of some auto-antibodies. These antibodies are not associated with symptoms, but are expressed in patients with concomitant diseases, obscuring the pathophysiology and clinical picture of MC.
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Amador-Patarroyo MJ, Arbelaez JG, Mantilla RD, Rodriguez-Rodriguez A, Cárdenas-Roldán J, Pineda-Tamayo R, Guarin MR, Kleine LL, Rojas-Villarraga A, Anaya JM. Sjögren’s syndrome at the crossroad of polyautoimmunity. J Autoimmun 2012; 39:199-205. [DOI: 10.1016/j.jaut.2012.05.008] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Accepted: 05/20/2012] [Indexed: 12/26/2022]
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Bournia VK, Vlachoyiannopoulos PG. Subgroups of Sjögren syndrome patients according to serological profiles. J Autoimmun 2012; 39:15-26. [PMID: 22575069 DOI: 10.1016/j.jaut.2012.03.001] [Citation(s) in RCA: 113] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Sjögren Syndrome (SS) is a systemic, autoimmune disorder characterized by lymphocytic infiltration of the exocrine glands. Different clinical associations have been described for each of the diverse autoantibodies found in SS patients. Antibodies directed against the Ro/La ribonucleoprotein complexes have been correlated with younger age, more severe dysfunction of the exocrine glands and a higher prevalence of extraglandular manifestations. Anti-nuclear antibodies and rheumatoid factors have been associated to extraglandular manifestations and an active immunological profile, while cryoglobulins are markers of more severe disease and correlate to lymphoma development and death. Antibodies to cyclic citrullinated peptides are scarce in SS and have been linked in some cases to the development of non-erosive arthritis. Furthermore, the presence of anti-mitochondrial antibodies and anti-smooth muscle antibodies in the sera of primary SS patients is considered indicative of primary biliary cirrhosis and autoimmune hepatitis, respectively. In addition, anti-centromere antibodies have been associated with a clinical phenotype intermediate between primary SS and systemic sclerosis, while antibodies against carbonic anhydrase have been related to renal tubular acidosis. Finally, an association of anti-muscarinic antibodies with cytopenias and a higher disease activity has also been described in primary SS. In conclusion, although not all of the above mentioned antibodies are useful for predicting distinct patient subgroups in SS, knowledge of the clinical associations of the different autoantibody specificities encountered in SS can advance our understanding of the disease and improve patient management.
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Affiliation(s)
- Vasiliki-Kalliopi Bournia
- Department of Pathophysiology, Medical School, University of Athens, Mikras Asias 75, 115 27 Athens, Greece
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