Primary Sjogren’s syndrome and the risk of acute pancreatitis: a nationwide cohort study

Abstract

ObjectiveStudies on the risk of acute pancreatitis in patients with primary Sjogren’s syndrome (pSS) are limited. We evaluated the effects of pSS on the risk of acute pancreatitis in a nationwide, population-based cohort in Taiwan.Study designPopulation-based retrospective cohort study.SettingWe studied the claims data of the >97% Taiwan population from 2002 to 2012.ParticipantsWe identified 9468 patients with pSS by using the catastrophic illness registry of the National Health Insurance Database in Taiwan. We also selected 37 872 controls that were randomly frequency matched by age (in 5 year bands), sex and index year from the general population.Primary outcome measureWe analysed the risk of acute pancreatitis by using Cox proportional hazards regression models including sex, age and comorbidities.ResultsFrom 23.74 million people in the cohort, 9468 patients with pSS (87% women, mean age=55.6 years) and 37 872 controls were followed-up for 4.64 and 4.74 years, respectively. A total of 44 cases of acute pancreatitis were identified in the pSS cohort versus 105 cases in the non-pSS cohort. Multivariate Cox regression analysis indicated that the incidence rate of acute pancreatitis was significantly higher in the pSS cohort than in the non-pSS cohort (adjusted HR (aHR) 1.48, 95% CI 1.03 to 2.12). Cyclophosphamide use increased the risk of acute pancreatitis (aHR 5.27, 95% CI 1.16 to 23.86). By contrast, hydroxychloroquine reduced the risk of acute pancreatitis (aHR 0.23, 95% CI 0.09 to 0.55).ConclusionThis nationwide, retrospective cohort study demonstrated that the risk of acute pancreatitis was significantly higher in patients with pSS than in the general population.

Mastitis in Autoimmune Diseases: Review of the Literature, Diagnostic Pathway, and Pathophysiological Key Players

“…Their ductal cells share common receptors such as the SSa antigen [35]. This explains why autoimmune diseases such as SjS might target these two glands concomitantly and this is perfectly in line with the literature which considers Sjögren's syndrome as "autoimmune epithelitis" [36,37].…”

Recommendations for evaluation and diagnosis of extra-glandular manifestations of primary Sjögren syndrome: results of an epidemiologic systematic review/meta-analysis and a consensus guideline from the Brazilian society of rheumatology (hepatic, gastrointestinal and pancreatic)

“…Acute pancreatitis prevalence in Sjögren´s syndrome ranges from 0.5% [79,84] to 3% [85]. In Taiwan, 44 cases of acute pancreatitis (Table 5) were found among 9468 pSS patients, an incidence significantly higher than in the control group (0.46% versus 0.28%, respectively) [86]. An attending study on autoimmune pancreatitis (AIP) in Japan pointed to the diagnosis of SS in 25% of 54 AIP patients [87].…”

“…The use of cyclophosphamide seems to be associated with an increased risk of acute pancreatitis, possibly due to direct toxicity or, perhaps, because it is a marker of more severe systemic disease. Hydroxychloroquine use reduces the risk [86]. In addition to the typical exposures such as alcoholism, gallstone, and metabolic factors, autoimmune diseases also increase the chance for pancreatitis [78,[85][86][87][88] and primary SS is an independent risk factor for its occurrence.…”

Primary Sjogren syndrome increases the risk of bisphosphonate-related osteonecrosis of the jaw

“…The large sample size and longitudinal nature of the database provide advantages for nonexperimental studies, including observational and descriptive studies. The accuracy and validity of diagnoses in the NHIRD have been evaluated 28 . The database provides basic information on every individual insured by the NHI program, including patient characteristics, records of outpatient visits, hospital admissions, drug prescriptions, and disease status and management.…”