Hydroxychloroquine is associated with a lower risk of polyautoimmunity: data from the RELESSER Registry

Abstract

Objectives This article estimates the frequency of polyautoimmunity and associated factors in a large retrospective cohort of patients with SLE. Methods RELESSER (Spanish Society of Rheumatology Lupus Registry) is a nationwide multicentre, hospital-based registry of SLE patients. This is a cross-sectional study. The main variable was polyautoimmunity, which was defined as the co-occurrence of SLE and another autoimmune disease, such as autoimmune thyroiditis, RA, scleroderma, inflammatory myopathy and MCTD. We also recorded the presence of multiple autoimmune syndrome, secondary SS, secondary APS and a family history of autoimmune disease. Multiple logistic regression analysis was performed to investigate possible risk factors for polyautoimmunity. Results Of the 3679 patients who fulfilled the criteria for SLE, 502 (13.6%) had polyautoimmunity. The most frequent types were autoimmune thyroiditis (7.9%), other systemic autoimmune diseases (6.2%), secondary SS (14.1%) and secondary APS (13.7%). Multiple autoimmune syndrome accounted for 10.2% of all cases of polyautoimmunity. A family history was recorded in 11.8%. According to the multivariate analysis, the factors associated with polyautoimmunity were female sex [odds ratio (95% CI), 1.72 (1.07, 2.72)], RP [1.63 (1.29, 2.05)], interstitial lung disease [3.35 (1.84, 6.01)], Jaccoud arthropathy [1.92 (1.40, 2.63)], anti-Ro/SSA and/or anti-La/SSB autoantibodies [2.03 (1.55, 2.67)], anti-RNP antibodies [1.48 (1.16, 1.90)], MTX [1.67 (1.26, 2.18)] and antimalarial drugs [0.50 (0.38, 0.67)]. Conclusion Patients with SLE frequently present polyautoimmunity. We observed clinical and analytical characteristics associated with polyautoimmunity. Our finding that antimalarial drugs protected against polyautoimmunity should be verified in future studies.

Myasthenia Gravis Coexisting With Primary Sjögren's Syndrome: Report of Three Cases and Literature Review

“…Another question is whether hydroxychloroquine (HCQ) can be used in patients with pSS and MG. HCQ is an essential drug for patients with CTDs including SLE and SS, but special caution should be taken when used in MG patients. Although data from the Spanish society of Rheumatology Lupus Registry showed that HCQ protected against polyautoimmunity for patients with SLE ( 38 ), Varan et al reported a case of SLE in which MG developed with the use of HCQ, and regressed with its withdrawal ( 39 ). In a series of 17 patients with SLE and MG, Jallouli et al found that eight patients (47%) developed MG after initiation of HCQ, but only one patient who received HCQ had an exacerbation of myasthenic symptoms ( 40 ).…”

Hydroxychloroquine: A Potential Ethical Dilemma for Rheumatologists during the COVID-19 Pandemic

“…HCQ has proved invaluable in the management of skin manifestations of SLE as well as other immunological-related skin disorders 16 . There are more wide-reaching effects of HCQ with a recent study reporting attenuation of polyautoimmunity in patients with SLE 17 . In a nationwide Spanish study of 3679 SLE patients with 13.6% having polyautoimmunity (comorbid autoimmune thyroiditis, RA, scleroderma, inflammatory myopathy, and mixed connective tissue disease), antimalarial drugs were associated with a lower risk of polyautoimmunity (OR 0.50, 95% CI 0.38-0.67) 17 .…”

“…There are more wide-reaching effects of HCQ with a recent study reporting attenuation of polyautoimmunity in patients with SLE 17 . In a nationwide Spanish study of 3679 SLE patients with 13.6% having polyautoimmunity (comorbid autoimmune thyroiditis, RA, scleroderma, inflammatory myopathy, and mixed connective tissue disease), antimalarial drugs were associated with a lower risk of polyautoimmunity (OR 0.50, 95% CI 0.38-0.67) 17 . An important advantage of HCQ is safety in pregnancy, first reported by Buchanan and colleagues in the United Kingdom in 1992 18 .…”

Immune Modulation as a Therapeutic Option During the SARS-CoV-2 Outbreak: The Case for Antimalarial Aminoquinolines

“…During SLE and primary APS, HCQ administration decreases levels of type I IFN in patients' serum, and expression of type I interferon (IFN)-inducible genes in peripheral blood mononuclear cells ( 62 ). In a retrospective cohort of 3,679 Spanish SLE patients, HCQ treatment conferred an odds ratio of 0.5 for polyautoimmunity ( 63 ). Healthcare registry data for 220 million individuals showed that HCQ intake was associated with a lower risk for coronary artery disease ( 64 ).…”