Comorbidities associated with Sjögren's syndrome: Results from the Nationwide Inpatient Sample.

Terah Koch, Ibtisam Al-Hashimi, Boyd M. Koffman, Abhishek Deshpande, Sadik A. Khuder

Abstract


Although multiple comorbidities associated with Sjögren’s syndrome (SS) have been reported, reliable data regarding the prevalence of specific comorbidities among patients with SS remain sparse. In this study, we investigated the prevalence and risk for a broad spectrum of medical conditions among patients with SS in the United States. The Health Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) data was utilized in order to investigate 29 different comorbidities among SS patients. Between the years 2007 to 2009 there were 19,127 admissions with SS listed as principal diagnosis (1.3%) and secondary diagnosis (98.7%). Compared with 57,381 controls, SS patients had significantly higher prevalence of lymphoma (OR 1.6), valvular disease (OR 1.42), congestive heart failure (OR 1.28), hypothyroidism (OR 1.24), paralysis (OR 1.24), deficiency anemia (OR 1.16), depression (OR 1.18), neurological disorders (OR 1.17), and chronic pulmonary disease (OR 1.07). SS is associated with substantial medical conditions that may impact morbidity and mortality as well as quality of life for individuals suffering from SS.


Keywords


Sjögren’s syndrome, autoimmune diseases, comorbidities, HCUP data

Full Text:

PDF

References


Fox, R.I. (2005) Sjögren’s syndrome. Lancet 366, 321-331.

Kassan, S.S. (2004) Moutsopoulos HM. Clinical manifestations and early diagnosis of Sjögren's syndrome. Arch Intern Med 164(12), 1275-84.

Valim, V., Zandonade, E., Pereira, A.M., de Brito Filho, O.H., Serrano, E.V., Musso, C., Giovelli, R.A., and Ciconelli, R.M. (2013) Primary Sjögren’s syndrome prevalence in a major metropolitan area in Brazil. Revista brasileira de reumatologia 53, 24-34.

Somers, E.C., Thomas, S.L., Smeeth, L., and Hall, A.J. (2006) Autoimmune diseases co-occurring within individuals and within families: a systematic review. Epidemiology (Cambridge, Mass.) 17, 202-217.

Somers, E.C., Thomas, S.L., Smeeth, L., and Hall, A.J. (2009) Are individuals with an autoimmune disease at higher risk of a second autoimmune disorder? American journal of epidemiology 169, 749-755.

Kang JH, L.H. (2010) Comorbidities in patients with Primary Sjögren’s Syndrome: A Registry-based Case-control Study. J Rheumatol 37, 1188-1194.

Baldini, C., Pepe, P., Luciano, N., Ferro, F., Talarico, R., Grossi, S., Tavoni, A., and Bombardieri, S. (2012) A clinical prediction rule for lymphoma development in primary Sjögren’s syndrome. J Rheumatol 39, 804-808.

Johnsen, S.J., Brun, J.G., Goransson, L.G., Smastuen, M.C., Johannesen, T.B., Haldorsen, K., Harboe, E., Jonsson, R., Meyer, P.A., and Omdal, R. (2013) Risk of non-Hodgkin's lymphoma in primary Sjögren’s syndrome: a population-based study. Arthritis care & research 65, 816-821.

Szodoray, P., Barta, Z., Lakos, G., Szakall, S., and Zeher, M. (2004) Coeliac disease in Sjögren’s syndrome--a study of 111 Hungarian patients. Rheumatology international 24, 278-282.

Yoshikawa, K., Hatate, J., Toratani, N., Sugiura, S., Shimizu, Y., Takahash, T., Ito, T., and Fukunaga, R. (2012) Prevalence of Sjögren’s syndrome with dementia in a memory clinic. Journal of the neurological sciences 322, 217-221.

Gaches, F., Delaire, L., Nadalon, S., Loustaud-Ratti, V., and Vidal, E. (1998) [Frequency of autoimmune diseases in 218 patients with autoimmune thyroid pathologies]. La Revue de medecine interne / fondee ... par la Societe nationale francaise de medecine interne 19, 173-179.

Inal, V., Kitapcioglu, G., Karabulut, G., Keser, G., and Kabasakal, Y. (2010) Evaluation of quality of life in relation to anxiety and depression in primary Sjögren’s syndrome. Modern rheumatology / the Japan Rheumatism Association 20, 588-597.

The Healthcare Cost and Utilization Project (HCUP). [cited 2013 Janurary 15]; Available from: .

Alamanos, Y., Tsifetaki, N., Voulgari, P.V., Venetsanopoulou, A.I., Siozos, C., and Drosos, A.A. (2006) Epidemiology of primary Sjögren’s syndrome in north-west Greece, 1982-2003. Rheumatology (Oxford) 45, 187-191.

Andonopoulos, A.P., Drosos, A.A., Skopouli, F.N., Acritidis, N.C., and Moutsopoulos, H.M. (1987) Secondary Sjögren’s syndrome in rheumatoid arthritis. J Rheumatol 14, 1098-1103.

Ohara, T., Itoh, Y., and Itoh, K. (2000) Reevaluation of laboratory parameters in relation to histological findings in primary and secondary Sjögren’s syndrome. Internal medicine (Tokyo, Japan) 39, 457-463.

Zhou, J.G., Qing, Y.F., Jiang, L., Yang, Q.B., and Luo, W.F. (2010) Clinical analysis of primary Sjögren’s syndrome complicating anemia. Clinical rheumatology 29, 525-529.

Theander, E., Henriksson, G., Ljungberg, O., Mandl, T., Manthorpe, R., and Jacobsson, L.T. (2006) Lymphoma and other malignancies in primary Sjögren’s syndrome: a cohort study on cancer incidence and lymphoma predictors. Annals of the rheumatic diseases 65, 796-803.

Solans-Laque, R., Lopez-Hernandez, A., Bosch-Gil, J.A., Palacios, A., Campillo, M., and Vilardell-Tarres, M. (2011) Risk, predictors, and clinical characteristics of lymphoma development in primary Sjögren’s syndrome. Seminars in arthritis and rheumatism 41, 415-423.

Dong, L., Chen, Y., Masaki, Y., Okazaki, T., and Umehara, H. (2013) Possible Mechanisms of Lymphoma Development in Sjögren’s Syndrome. Current immunology reviews 9, 13-22.

Vassiliou, V.A., Moyssakis, I., Boki, K.A., and Moutsopoulos, H.M. (2008) Is the heart affected in primary Sjögren’s syndrome? An echocardiographic study. Clinical and experimental rheumatology 26, 109-112.

Al-Hashimi, I., Khuder, S., and Haghighat, N. (2001) Frequency and predictive value of the clinical manifestations in Sjögren’s syndrome. Journal of Oral Pathology and Medicine 30: 1-6.

Alfaris, N., Curiel, R., Tabbara, S., and Irwig, M.S. (2010) Autoimmune thyroid disease and Sjogren syndrome. Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases 16, 146-147.

Westhoff, G., Dorner, T., and Zink, A. (2012) Fatigue and depression predict physician visits and work disability in women with primary Sjögren’s syndrome: results from a cohort study. Rheumatology (Oxford) 51, 262-269.

Valtysdottir, S.T., Gudbjörnsson, B., Lindqvist, U., Hallgren, R. and Hetta, J. (2000) Anxiety and depression in in patients with primary Sjögren’s syndrome. Journal of Rheumatology 27, 165-169.

Spezialetti, R., Bluestein, H.G., Peter, J.B., and Alexander, E.L. (1993) Neuropsychiatric disease in Sjögren's syndrome: anti-ribosomal P and anti-neuronal antibodies. The American journal of medicine 95, 153-160.

Mandl, T., Hammar, O., Theander, E., Wollmer, P., and Ohlsson, B. (2010) Autonomic nervous dysfunction development in patients with primary Sjögren’s syndrome: a follow-up study. Rheumatology (Oxford) 49, 1101-1106.

Hatron, P.Y., Tillie-Leblond, I., Launay, D., Hachulla, E., Fauchais, A.L., and Wallaert, B. (2011) Pulmonary manifestations of Sjögren’s syndrome. Presse medicale (Paris, France : 1983) 40, e49-64.

Strimlan, C.V., Rosenow, E.C. III, Divertie, M.B., Harrison, E.G. Jr. (2003) Pulmonary manifestations of Sjögren’s syndrome. Chest 70,354-61.

Wright, S.A., Convery, R.P., Liggett, N. (2003) Pulmonary involvement in Sjögren’s syndrome. Rheumatology 42,697-8.

Marrie, R.A. (2007) Autoimmune disease and multiple sclerosis: methods, methods, methods. Lancet Neurol 6, 575–76.