Introducing Polyautoimmunity: Secondary Autoimmune Diseases No Longer Exist

Abstract

Similar pathophysiological mechanisms within autoimmune diseases have stimulated searches for common genetic roots. Polyautoimmunity is defined as the presence of more than one autoimmune disease in a single patient. When three or more autoimmune diseases coexist, this condition is called multiple autoimmune syndrome (MAS). We analyzed the presence of polyautoimmunity in 1,083 patients belonging to four autoimmune disease cohorts. Polyautoimmunity was observed in 373 patients (34.4%). Autoimmune thyroid disease (AITD) and Sjögren's syndrome (SS) were the most frequent diseases encountered. Factors significantly associated with polyautoimmunity were female gender and familial autoimmunity. Through a systematic literature review, an updated search was done for all MAS cases (January 2006–September 2011). There were 142 articles retrieved corresponding to 226 cases. Next, we performed a clustering analysis in which AITD followed by systemic lupus erythematosus and SS were the most hierarchical diseases encountered. Our results indicate that coexistence of autoimmune diseases is not uncommon and follows a grouping pattern. Polyautoimmunity is the term proposed for this association of disorders, which encompasses the concept of a common origin for these diseases.

Homozygosity Analysis in Autoimmunity Affected Individuals and Multiplex Autoimmune Disease Families

“…The first comes from clinical observations indicating the possible shift from one disease to another or to the fact that more than one AD may coexist in a single patient (i.e., polyA, MAS) [24,[36][37][38][39] in the same family (i.e., familial autoimmunity) [40]. The second level of evidence refers to known shared pathophysiological mechanisms between ADs [41]; and the third level of evidence corresponds to the evidence implying common genetic factors [38].…”

“…All Patients fulfilled the diagnostic classification criteria proposed per disease as previously applied [23,24]. All T1D affected cases were children all of whom fulfilled the diagnostic classification criteria proposed by the American Diabetes Association (ADA) [25], as has been previously described ( …”

Corticoid Therapy for Overlapping Syndromes in an HIV-positive Patient

“…In addition, systemic rheumatic diseases are known to coincide with each other and/or other autoimmune disorders, including autoimmune adrenal insufficiency (Addison's disease), autoimmune hepatitis (AIH), autoimmune thyroid disease, antiphospholipid syndrome, biliary inflammatory diseases such as primary sclerosing cholangitis and primary biliary cirrhosis, celiac disease, inflammatory bowel diseases such as ulcerative colitis and Crohn's disease, myasthenia gravis, sarcoidosis, type 1 diabetes mellitus and vasculitis (3).…”

Rat Model for Poly-Autoimmunity

“…There is vast literature on neuro-immuno-endocrynology with excellent reviews on multiple-autoimmunity, i.e., the existence of several autoimmune diseases (Bergsteinsdottir et al, 2000;Rojas-Villarraga et al, 2012;NNE, 2012). The numerous studies describing different parts in the hypothalamic-pituitary-adrenal axis and the interplay between the gonadal steroids and the immune system, with respect to autoimmunity in the central nervous system, have been critically reviwed (Mason et al, 1990;Whitacre, 2001;Arnaud, 2009;ZandmanGoddard et al, 2012;Zhang et al, 2012).…”