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- Title
Infections increase the risk of developing Sjögren's syndrome.
- Authors
Mofors, J.; Björk, A.; Kvarnström, M.; Wahren‐Herlenius, M.; Arkema, E. V.; Westermark, L.; Nordmark, G.; Forsblad‐d'Elia, H.; Magnusson Bucher, S.; Eriksson, P.; Mandl, T.; Forsblad-d'Elia, H; Wahren-Herlenius, M
- Abstract
<bold>Objective: </bold>Environmental factors have been suggested in the pathogenesis of rheumatic diseases. We here investigated whether infections increase the risk of developing primary Sjögren's syndrome (pSS).<bold>Methods: </bold>Patients with pSS in Sweden (n = 945) and matched controls from the general population (n = 9048) were included, and data extracted from the National Patient Register to identify infections occurring before pSS diagnosis during a mean observational time of 16.0 years. Data were analysed using conditional logistic regression models. Sensitivity analyses were performed by varying exposure definition and adjusting for previous health care consumption.<bold>Results: </bold>A history of infection associated with an increased risk of pSS (OR 1.9, 95% CI 1.6-2.3). Infections were more prominently associated with the development of SSA/SSB autoantibody-positive pSS (OR 2.7, 95% CI 2.0-3.5). When stratifying the analysis by organ system infected, respiratory infections increased the risk of developing pSS, both in patients with (OR 2.9, 95% CI 1.8-4.7) and without autoantibodies (OR 2.1, 95% CI 1.1-3.8), whilst skin and urogenital infections only significantly associated with the development of autoantibody-positive pSS (OR 3.2, 95% CI 1.8-5.5 and OR 2.7, 95% CI 1.7-4.2). Furthermore, a dose-response relationship was observed for infections and a risk to develop pSS with Ro/SSA and La/SSB antibodies. Gastrointestinal infections were not significantly associated with a risk of pSS.<bold>Conclusions: </bold>Infections increase the risk of developing pSS, most prominently SSA/SSB autoantibody-positive disease, suggesting that microbial triggers of immunity may partake in the pathogenetic process of pSS.
- Subjects
SWEDEN; DOSE-response relationship in biochemistry; RESPIRATORY infections; RHEUMATISM; SKIN infections; INFECTION
- Publication
Journal of Internal Medicine, 2019, Vol 285, Issue 6, p670
- ISSN
0954-6820
- Publication type
journal article
- DOI
10.1111/joim.12888