Cardiovascular Events, Sleep Apnoea, and Pulmonary Hypertension in Primary Sjögren’s Syndrome: Data from the French Health Insurance Database

Goulabchand, Radjiv; Roubille, Camille; Montani, David; Fesler, Pierre; Bourdin, Arnaud; Malafaye, Nicolas; Morel, Jacques; Arnaud, E.; Lattuca, Benoît; Barateau, Lucie; Guilpain, Philippe; Mura, Thibault

doi:10.3390/jcm10215115

Cited by 11 publications

(9 citation statements)

References 44 publications

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“…Excluding these patients meant that the control group presented a disease severity level more comparable to the pSS patients. This cohort has been described in previous studies [ 11 , 12 ].…”

Section: Methodsmentioning

confidence: 99%

Hospitalization Risks for Neurological Disorders in Primary Sjögren’s Syndrome Patients

Goulabchand

Gabelle

Ayrignac

et al. 2022

JCM

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Primary Sjögren’s syndrome (pSS) can be associated with neurological and cognitive involvement, negatively affecting patients’ quality of life. The aim of this study was to assess whether pSS patients are at higher risk of hospitalization for neurological diseases. Through a nationwide retrospective study using the French Health insurance database (based on International Classification for Disease codes, ICD-10), we selected patients hospitalized with new-onset pSS between 2011 and 2018. We compared the incidence of hospitalization for dementia, multiple sclerosis (MS), encephalitis, and peripheral neuropathy with an age- and sex-matched (1:10) hospitalized control group. Adjusted Hazard Ratios (aHR) considered confounding factors, particularly socio-economic status and cardiovascular diseases. We analyzed 25,661 patients hospitalized for pSS, compared with 252,543 matched patients. The incidence of hospitalization for dementia was significantly higher in pSS patients (aHR = 1.27 (1.04–1.55); p = 0.018), as well as the incidence of hospitalization for MS, encephalitis, and inflammatory polyneuropathies (aHR = 3.66 (2.35–5.68), p < 0.001; aHR = 2.66 (1.22–5.80), p = 0.014; and aHR = 23.2 (12.2–44.5), p < 0.001, respectively). According to ICD-10 codes, pSS patients exhibited a higher incidence of hospitalization for dementia, encephalitis, MS, and peripheral neuropathies than controls. Physicians must be aware of these neurological risks to choose the most appropriate diagnostic work-up.

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Section: Methodsmentioning

confidence: 99%

Hospitalization Risks for Neurological Disorders in Primary Sjögren’s Syndrome Patients

Goulabchand

Gabelle

Ayrignac

et al. 2022

JCM

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“…Overall, PH is encountered in less than 5% of patients affected by SS ( 70 ). Even so, a recent study revealed that patients with pSS have a higher incidence of hospitalisation related to PH, compared to the general population (aHR = 3.32) ( 91 ). Pulmonary arterial hypertension (PAH) is also considered a rare complication in patients with pSS ( 69 ).…”

Section: Cardiovascular Involvement In Sjogren’s Syndromementioning

confidence: 99%

“…It is known that obstructive sleep apnea (OSA) can induce pulmonary hypertension through hypoxia, as well as contributing to the cardiovascular risk of the individual. A recent study highlighted that hospitalized patients with pSS have a significantly higher incidence of OSA, independently of obesity (AHR= 1.97, [95% CI 1.70- 2.28]; P< 0.001) ( 91 ).…”

Section: Cardiovascular Involvement In Sjogren’s Syndromementioning

confidence: 99%

“…Even if this particular population is not yet formally considered a high risk one in terms of cardiovascular diseases by the current prevention tools, clinicians should be aware that patients with pSS have a higher risk for developing cardiovascular diseases, as previously discussed ( 16 , 17 ). Furthermore, these patients have a higher prevalence of cardiovascular risk factors, such as hypertension, hypertriglyceridaemia, OSA and possibly diabetes mellitus ( 15 – 20 , 91 ). We should mention that no specific recommendations have been formulated in the primary prevention of patients with pSS ( 30 ).…”

Section: Current Evidence On Cardiovascular Preventionmentioning

confidence: 99%

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Cardiovascular Disease in Primary Sjögren’s Syndrome: Raising Clinicians’ Awareness

Casian

Jurcuţ²,

Dima

et al. 2022

Front. Immunol.

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In the ever evolving landscape of systemic immune mediated diseases, an increased awareness regarding the associated cardiovascular system impairment has been noted in recent years. Even though primary Sjögren’s Syndrome (pSS) is one of the most frequent autoimmune diseases affecting middle-aged individuals, the cardiovascular profile of this specific population is far less studied, at least compared to other autoimmune diseases. Traditional cardiovascular risk factors and disease specific risk factors are inextricably intertwined in this particular case. Therefore, the cardiovascular risk profile in pSS is a multifaceted issue, sometimes difficult to assess. Furthermore, in the era of multimodality imaging, the diagnosis of subclinical myocardial and vascular damage is possible, with recent data pointing that the prevalence of such involvement is higher in pSS than in the general population. Nevertheless, when approaching patients with pSS in terms of cardiovascular diseases, clinicians are often faced with the difficult task of translating data from the literature into their everyday practice. The present review aims to synthesize the existing evidence on pSS associated cardiovascular changes in a clinically relevant manner.

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“…Patients may additionally experience a diversity of extraglandular disease manifestations which can cause substantial morbidity (10). Patients with pSS appear to exhibit accelerated (subclinical) atherosclerosis and other cardiovascular risk factors, which is also seen in other autoimmune rheumatic diseases, including systemic lupus erythematosus (SLE) (11)(12)(13)(14).…”

Section: Introductionmentioning

confidence: 99%

Trained Immunity in Primary Sjögren’s Syndrome: Linking Type I Interferons to a Pro-Atherogenic Phenotype

et al. 2022

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BackgroundTrained immunity – or innate immune memory – can be described as the long-term reprogramming of innate immune cells towards a hyperresponsive state which involves intracellular metabolic changes. Trained immunity has been linked to atherosclerosis. A subgroup of patients with primary Sjögren’s syndrome (pSS) exhibits systemic type I interferon (IFN) pathway activation, indicating innate immune hyperactivation. Here, we studied the link between type I IFNs and trained immunity in an in vitro monocytic cell model and peripheral blood mononuclear cells (PBMCs) from pSS patients.MethodsThe training stimuli heat killed Candida albicans, muramyl dipeptide, IFNβ, and patient serum were added to THP-1 cells for 24 hours, after which the cells were washed, rested for 48 hours and subsequently re-stimulated with LPS, Pam3Cys, poly I:C, IFNβ or oxLDL for 4-24 hours. PBMCs from pSS patients and healthy controls were stimulated with LPS, Pam3Cys, poly I:C or IFNβ for 0.5-24 hours.ResultsTraining with IFNβ induced elevated production of pro-atherogenic cytokines IL-6, TNFα and CCL2, differential cholesterol- and glycolysis-related gene expression, and increased glucose consumption and oxLDL uptake upon re-stimulation. Type I IFN production was increased in Candida albicans- and IFNβ-trained cells after LPS re-stimulation, but was reduced after poly I:C re-stimulation. Training with muramyl dipeptide and IFNβ, but not Candida albicans, affected the IFN-stimulated gene expression response to IFNβ re-stimulation. PBMCs from pSS patients consumed more glucose compared with healthy control PBMCs and tended to produce more TNFα and type I IFNs upon LPS stimulation, but less type I IFNs upon poly I:C stimulation.ConclusionsType I IFN is a trainer inducing a trained immunity phenotype with pro-atherogenic properties in monocytes. Conversely, trained immunity also affects the production of type I IFNs and transcriptional response to type I IFN receptor re-stimulation. The phenotype of pSS PBMCs is consistent with trained immunity. This connection between type I IFN, trained immunity and cholesterol metabolism may have important implications for pSS and the pathogenesis of (subclinical) atherosclerosis in these patients.

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Cardiovascular Events, Sleep Apnoea, and Pulmonary Hypertension in Primary Sjögren’s Syndrome: Data from the French Health Insurance Database

Cited by 11 publications

References 44 publications

Hospitalization Risks for Neurological Disorders in Primary Sjögren’s Syndrome Patients

Hospitalization Risks for Neurological Disorders in Primary Sjögren’s Syndrome Patients

Cardiovascular Disease in Primary Sjögren’s Syndrome: Raising Clinicians’ Awareness

Trained Immunity in Primary Sjögren’s Syndrome: Linking Type I Interferons to a Pro-Atherogenic Phenotype

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