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Kridin K, Goychberg R, Kridin M, Kafri N, Barhoum M, Cohen AD. The cardiovascular risk in bullous pemphigoid: Insights from a population-based study. Australas J Dermatol 2024; 65:e187-e193. [PMID: 39087452 DOI: 10.1111/ajd.14355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 07/08/2024] [Accepted: 07/17/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND The risk of life-threatening major cardiovascular outcomes among patients with bullous pemphigoid (BP) is inconsistent in the current literature. OBJECTIVE To evaluate the risk and prognostic outcomes of myocardial infarction (MI), cerebrovascular accident (CVA), peripheral vascular disease (PVD) and pulmonary embolism (PE) in patients with BP. We additionally aimed to explore the influence of different therapeutic approaches on the risk of these outcomes. METHODS A population-based retrospective cohort study was conducted to compare BP patients (n = 3924) with age-, gender- and ethnicity-matched control subjects (n = 19,280) with regard to incident cases of MI, CVA, PVD and PE. Adjusted hazard ratio (HR) and 95% confidence intervals (CI) were estimated by multivariate Cox regression analysis. Data were retrieved from Clalit Health Services' computerized database. RESULTS Relative to their matched controls, patients with BP were at an elevated risk of MI (fully-adjusted HR: 1.44; 95% CI: 1.14-1.81; p = 0.002), CVA (fully-adjusted HR: 1.24; 95% CI: 1.06-1.45; p = 0.007), PVD (fully-adjusted HR: 1.60; 95% CI: 1.27-2.03; p = 0.003) and PE (fully-adjusted HR: 1.72; 95% CI: 1.28-2.32; p < 0.008). Patients with BP experienced heightened risk of all-cause mortality in the presence of comorbid MI (fully-adjusted HR: 1.61; 95% CI: 1.44-1.81; p < 0.001), CVA (fully-adjusted HR: 1.70; 95% CI: 1.52-1.89; p < 0.001), PVD (fully-adjusted HR: 1.38; 95% CI: 1.20-1.58; p < 0.001) and PE (fully-adjusted HR: 1.44; 95% CI: 1.10-1.88; p = 0.007). The therapeutic approach utilized to manage BP did not significantly influence the risk of cardiovascular outcomes. CONCLUSIONS BP is associated with an elevated risk of MI, CVA, PVD, PE and cardiovascular mortality. Primary, secondary and tertiary cardiovascular prevention measures should be implemented among patients with BP.
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Kridin K, Ankary-Khaner M, Kridin M, Cohen AD, Badarny S. Hematological malignancy-associated pyoderma gangrenosum: evaluating the magnitude of the association. Front Med (Lausanne) 2024; 11:1425454. [PMID: 39118665 PMCID: PMC11306151 DOI: 10.3389/fmed.2024.1425454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 07/17/2024] [Indexed: 08/10/2024] Open
Abstract
Background Hematologic malignancies (HMs) are well-known underlying comorbidities of pyoderma gangrenosum (PG). However, studies quantifying the likelihood of PG after HMs are yet to be performed. Objective To investigate the bidirectional association between PG and several HMs, namely acute leukemia, chronic leukemia, Hodgkin lymphoma, non-Hodgkin lymphoma, and multiple myeloma. Methods A population-based retrospective cohort study was conducted to study the risk of HMs in patients with PG (n = 302) as compared to age-, sex-and ethnicity-matched control subjects (n = 1,799). A case-control design was used to estimate the likelihood of PG in individuals with a preexisting history of HMs. Adjusted hazard ratios (HRs) and adjusted odds ratios (ORs) were estimated by Cox regression and logistic regression, respectively. Results The prevalence of preexisting HM was higher in patients with PG than in controls (6.7% vs. 0.9%, respectively). The likelihood of having PG was significantly greater among patients with a history of HM (adjusted OR, 7.88; 95% CI, 3.85-16.15; p < 0.001), particularly during the first year following the diagnosis. This association was significant for acute leukemia, chronic leukemia, non-Hodgkin lymphoma, and multiple myeloma but not for Hodgkin lymphoma. The incidence rate of HM was 3.3 (95% CI, 1.2-7.4) and 1.6 (95% CI, 0.9-2.6)/1,000 person-years among patients with PG and controls, respectively. Relative to controls, patients with PG were not more likely to develop subsequent HM (adjusted HR, 2.22; 95%CI, 0.77-6.45; p = 0.142). Compared to other patients with PG, those with HM-associated PG experienced an increased all-cause mortality rate (adjusted HR, 2.19; 95%CI, 1.09-4.40; p = 0.028). Conclusion HM, particularly acute leukemia and multiple myeloma, are associated with an elevated likelihood of provoking PG.
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Weinstein O, Kridin M, Kridin K, Mann O, Cohen AD, Zloto O. The risk of retinal vein occlusion among patients with neovascular age related macular degeneration: a large-scale cohort study. Eye (Lond) 2023; 37:1445-1450. [PMID: 35778605 PMCID: PMC10170074 DOI: 10.1038/s41433-022-02163-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 06/16/2022] [Accepted: 06/20/2022] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To examine the risk for retinal-vein-occlusion (RVO) in patients with neovascular age-related-macular-degeneration (AMD) as compared to age- and sex-matched controls. METHOD This is a population-based, cohort study. The study encompassed 24,578 consecutive patients with neovascular AMD and 66,129 control subjects. Multivariate cox regression analysis was utilized to detect the risk of RVO among patients with neovascular AMD. Predictors of RVO in patients with neovascular AMD were identified using multivariate logistic regression analysis. Mortality of patients was assessed using Kaplan-Meier method. RESULTS The incidence rate of RVO was estimated at 1.25 (95% CI, 1.06-1.45) per 1000 person-years among patients with neovascular AMD and 0.25 (95% CI, 0.20-0.31) per 1000 person-years among controls. Patients with neovascular AMD were associated with an increased risk of RVO (adjusted HR, 4.35; 95% CI, 3.34-5.66; P < 0.001). Among patients with neovascular AMD, older age (≥79.0 years) was associated with a decreased risk of RVO (adjusted OR, 0.50; 95% CI, 0.37-0.70; P < 0.001), whilst a history of glaucoma increased the likelihood of RVO (adjusted OR, 2.66; 95% CI, 1.94-3.65; P < 0.001). Patients with neovascular AMD and comorbid RVO had a comparable risk of all-cause mortality relative to other patients with neovascular AMD (HR, 0.90; 95% CI, 0.67-1.22; P = 0.500) CONCLUSIONS: An increased risk of RVO was found among patients with neovascular AMD. Younger age and glaucoma predicted the development of RVO in patients with neovascular AMD. Awareness of this comorbidity is of benefit for clinicians as patients with neovascular AMD might be carefully examined for RVO signs and complications.
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Kridin M, Zloto O, Kridin K, Cohen AD, Mann O, Weinstein O. The association of uveitis with hepatitis B and hepatitis C viruses: a large-scale population-based study. Eye (Lond) 2023; 37:720-724. [PMID: 35352013 PMCID: PMC9998628 DOI: 10.1038/s41433-022-02037-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/25/2022] [Accepted: 03/15/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To examine the association of uveitis with hepatitis B (HBV) and hepatitis C (HCV) chronic infections METHOD: This is a population-based cross-sectional study. The study encompassed 13,183 consecutive patients with uveitis and 65,331control subjects. The prevalence of chronic HBV and HCV infections was compared between patients diagnosed with uveitis and age-, sex-, and ethnicity-matched controls. Lifetime prevalence rates of HBV and HCV were calculated for patients with uveitis and control individuals. Odds ratio (OR) for HBV and HCV was evaluated across different strata. RESULTS The lifetime prevalence rate of chronic HBV infection was greater in patients with uveitis than in controls (1.2% vs. 0.8%, respectively; P < 0.001). The association of HBV with uveitis was statistically significant among individuals older than 40 years of age, both sexes, and individuals of Jewish ethnicity. The lifetime prevalence of HCV was comparable between patients with uveitis and controls (0.8% vs. 0.7%, respectively; P = 0.189). Thus, no independently significant association was found between uveitis and HCV (fully-adjusted OR, 1.15; 95% CI, 0.93-1.42; P = 0.211). CONCLUSIONS Uveitis is associated with HBV. The association was more prominent among older and Jewish patients. Patients with uveitis may benefit from screening for HBV. An association between uveitis and HCV has not been found.
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Kridin K, Zelber-Sagi S, Kridin M, Cohen AD. Bullous pemphigoid and neuropsychiatric medications: An influence of drugs or of underlying conditions? J Am Acad Dermatol 2023; 88:e137. [PMID: 31004730 DOI: 10.1016/j.jaad.2019.03.091] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 03/12/2019] [Indexed: 11/16/2022]
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Kridin M, Kridin K, Cohen A, Amital H, Watad A. The risk, predictors, and outcomes of amyloidosis in ankylosing spondylitis: a longitudinal population-based cohort study. Rheumatology (Oxford) 2021; 61:2072-2078. [PMID: 34373900 DOI: 10.1093/rheumatology/keab633] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 06/16/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The risk of amyloidosis during the course of ankylosing spondylitis (AS) is yet to be firmly established. We aimed to evaluate the risk, predictors, and prognostic outcomes of amyloidosis among patients with AS. METHODS A population-based cohort study was conducted comparing AS patients (n = 5,911) with age-, sex- and ethnicity-matched control subjects (n = 29 007) with regard to incident cases of amyloidosis. Hazard ratios (HRs) and odds ratios (ORs) were estimated by Cox regression and logistic regression analyses, respectively. RESULTS The incidence rate of amyloidosis was 2.15 (95% CI, 1.09-2.82) and 0.35 (95% CI, 0.16-0.66) per 10 000 person-years among patients with AS and controls, respectively. The risk of incident amyloidosis was >6-folds higher among patients with AS relative to control subjects (adjusted HR, 6.16; 95% CI, 2.43-15.62; p< 0.001). A higher comorbidity burden (OR, 1.36; 95% CI, 1.08-1.73; p= 0.010) was found to predict an increased susceptibility to amyloidosis in AS patients. Compared with other patients with AS, those with AS and comorbid amyloidosis had a 14-fold increased risk of end-stage renal disease necessitating dialysis (adjusted HR, 14.7; 95% CI, 2.0-107.2; p= 0.008), but comparable risk of all-cause mortality (adjusted HR, 2.16; 95% CI, 0.69-6.71; p= 0.174). CONCLUSIONS Patients with AS are at an increased risk of amyloidosis. AS-associated amyloidosis is associated with an elevated risk of dialysis dependence. Awareness of the burden and consequences of this complication may be of help for rheumatologists managing patients with AS.
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Kridin K, Kridin M, Amital H, Watad A, Khamaisi M. Mortality in Patients with Polymyositis and Dermatomyositis in an Israeli Population. THE ISRAEL MEDICAL ASSOCIATION JOURNAL : IMAJ 2020; 22:623-627. [PMID: 33070486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND The reported mortality rates of patients with polymyositis and dermatomyositis are highly variable worldwide. The excess mortality of patients with polymyositis/dermatomyositis has not been evaluated in an Israeli population. OBJECTIVES To investigate the overall mortality in a large and well-established cohort of patients with polymyositis/dermatomyositis as compared to the mortality expected in the matched general population in a tertiary medical center. METHODS In this retrospective cohort study, the mortality of 166 patients with polymyositis/dermatomyositis was compared to age- and sex-matched control subjects in the general population. All-cause standardized mortality ratios (SMRs) were estimated. RESULTS Overall, 47 (28.3%) deaths were observed among patients with polymyositis/dermatomyositis during a mean follow-up period of 5.8 ± 4.8 years, which was 7 times higher than in the control group (SMR 7.4, 95% confidence interval [95%CI] 5.5-9.8). The SMRs were comparable in patents with polymyositis (7.7, 95%CI 4.8-12.3) and dermatomyositis (7.2, 95%CI 5.0-10.3). The 1-, 5-, 10-, and 15-year overall survival rates were 90.0%, 82.8%, 51.5%, and 26.1%, respectively, in patients with polymyositis, and 80.3%, 59.6%, 40.0%, and 17.1%, respectively, in patients with dermatomyositis. CONCLUSIONS The overall mortality among Israeli patients with polymyositis/dermatomyositis is 7.4 times greater than for the general population. Although long-term mortality was comparable between patients with dermatomyositis and polymyositis, patients in the former group died at a notably earlier stage.
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Laufer Britva R, Kridin M, Kridin K. Red Blood Cell Distribution Width Is Increased in Patients with Pemphigus: A Case-Control Study. ANNALS OF CLINICAL AND LABORATORY SCIENCE 2020; 50:253-259. [PMID: 32366565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Red blood cell distribution width (RDW) has recently emerged as an inflammatory marker in several inflammatory diseases but has not been investigated in patients with pemphigus. OBJECTIVE We aimed to examine RDW percentage in patients with pemphigus relative to control subjects and to assess the association between this biomarker and the morphological characteristics of the disease. METHODS This case-control study included 183 pemphigus patients and 915 age- and sex-matched control subjects. RDW, hemoglobin, and mean corpuscular volume (MCV) were measured for all study participants. RESULTS The RDW was significantly higher in patients with pemphigus than in controls (13.7±1.3 vs. 13.4±1.1%, respectively; P=0.001). A significant association between RDW and pemphigus was demonstrated in multivariate analysis (odds ratio, 1.22; 95% confidence interval, 1.01-1.46; P=0.036). The RDW was higher in patients with pemphigus vulgaris (PV) than in pemphigus foliaceus (PF; P=0.043), and in those with mucocutaneous PV relative to those with mucosal only and cutaneous only PV. The RDW increased significantly following treatment (P<0.001). CONCLUSION Pemphigus patients demonstrated elevated RDW as compared with healthy controls. RDW may be a feasible biomarker in patients with pemphigus. Although it clearly does not replace any of the accepted diagnostic immunopathological criteria, increased RDW may be more suggestive of PV than PF, and of mucocutaneous rather than cutaneous PV. The remarkable increase following treatment may be ascribed to the corticosteroid-induced erythropoiesis.
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Kridin K, Kridin M, Amber KT, Shalom G, Comaneshter D, Batat E, Cohen AD. The Risk of Pulmonary Embolism in Patients With Pemphigus: A Population-Based Large-Scale Longitudinal Study. Front Immunol 2019; 10:1559. [PMID: 31396203 PMCID: PMC6668600 DOI: 10.3389/fimmu.2019.01559] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 06/24/2019] [Indexed: 01/28/2023] Open
Abstract
Growing evidence suggests that inflammation may pose an atypical risk factor for pulmonary embolism (PE), as it drives venous thrombosis via several pathways. The increased risk of PE in several autoimmune diseases has lent weight to this concept. However, the relative risk of PE among patients with pemphigus has not yet been established. We aimed to examine the risk of PE in patients with pemphigus. A large-scale population-based longitudinal cohort study was conducted to evaluate the relative risk (RR) of PE among 1,985 patients with pemphigus relative to 9,874 age-, sex-, and ethnicity-matched control subjects. A multivariate Cox regression model was utilized. The incidence of PE was 3.0 (95% CI, 2.2–4.0) and 1.2 (95% CI, 1.0–1.5) per 1,000 person-years among patients with pemphigus and controls, respectively. The period prevalence of PE corresponding to the study period was 2.2% (95% CI, 1.6–2.9%) among cases and 0.9% (95% CI, 0.7–1.1%) among controls. Patients with pemphigus were twice as likely to develop PE as compared to control subjects (adjusted RR, 1.98; 95% confidence interval [CI], 1.29–3.04). The highest PE risk was observed during the 1st year following the diagnosis of pemphigus (adjusted RR, 3.55; 95% CI, 1.78–7.09) and decreased over time. The increased risk was robust to a sensitivity analysis that included only cases managed by pemphigus-related systemic medications (adjusted RR, 1.82; 95% CI, 1.11–2.98). In conclusion, pemphigus is associated with an increased risk of PE, particularly during the 1st year of the disease. An awareness of this risk should be increased, additional precipitating factors for PE should be avoided, and thromboprophylaxis may be evaluated in high-risk patients. Further research is required to establish this risk.
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Kridin K, Laufer-Britva R, Kridin M, Comaneshter D, Batat E, Cohen AD. The relationship between pemphigus and systemic lupus erythematosus: a cross-sectional study, systematic review, and meta-analysis. Immunol Res 2019; 67:116-122. [PMID: 30637663 DOI: 10.1007/s12026-019-9065-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The coexistence of pemphigus and systemic lupus erythematosus (SLE) had been reported anecdotally. Anti-desmoglein (Dsg)1 and anti-Dsg3 antibodies were detected concomitantly with antinuclear autoantibodies among blood donors. The aim of the current study was to study the association between pemphigus and SLE in Israeli patients and to synthesize existing data on this association in the current literature. The current study included two sections. Initially, a cross-sectional study was performed to compare pemphigus patients with age-, sex-, and ethnicity-matched control subjects regarding the prevalence of SLE using a real-life large-scale computerized database. Next, a systematic review and meta-analysis of similar observational studies in Medline, Embase, and Web of Science (1823-2017) was conducted. As for the cross-sectional study, a total of 1985 patients with pemphigus and 9874 controls were included in the study. The prevalence of SLE was slightly higher among patients with pemphigus as compared to controls (OR, 1.85; 95% CI, 0.89-3.82). In a sensitivity analysis that included patients who received pemphigus-related treatments, the association between pemphigus and SLE had been substantiated and was statistically significant (OR, 2.10; 95% CI, 1.00-4.48). In the meta-analysis section, three eligible studies, comprising 10,389 pemphigus patients met the eligibility criteria. The overall pooled multivariate OR was 2.50 (95% CI 1.54-4.07, I2 = 44.19%, P = 0.167) across all studies. In conclusion, the meta-analysis provides epidemiologic evidence that these B cell-driven diseases are significantly associated. Further research is required to elucidate the molecular mechanism underlying this association.
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Kridin K, Kridin M, Shalom G, Cohen AD. The coexistence of pemphigus and psoriasis: a systematic review and meta-analysis. Immunol Res 2018; 67:134-141. [PMID: 30338449 DOI: 10.1007/s12026-018-9031-6] [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] [Indexed: 12/29/2022]
Abstract
There is little consensus regarding the association between pemphigus and psoriasis. The aim of the current study is to synthesize existing data on the prevalence of psoriasis in patients with pemphigus and on the association between the two conditions. We performed a systematic review and meta-analysis of observational studies in Medline, Embase, and Web of Science (1900-2018). Reference lists of included studies were also searched for eligible studies. Quality of evidence was assessed using Newcastle-Ottawa scale (NOS). A meta-analysis was performed using random-effects models to estimate pooled prevalence rates and odds ratios (ORs) with 95% confidence intervals (CI). Subgroup and sensitivity analyses were also conducted. Twelve eligible studies comprising 12,238 patients with pemphigus were included in the quantitative synthesis. The overall random-effects pooled prevalence of psoriasis among patients with pemphigus was 2.4% (95% CI, 1.0-4.4) across all studies. The overall pooled multivariate OR for psoriasis in patients with pemphigus was significantly increased and estimated at 3.5 (95% CI, 1.6-7.6). In conclusion, a significant association was found between pemphigus and psoriasis. Physicians managing patients with pemphigus may be aware of this comorbidity. Further studies are warranted to establish the precise mechanisms underlying this relationship.
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