Abstract
ObjectivesTo investigate the association between tonsillitis and the risk of newly diagnosed ankylosing spondylitis (AS).MethodsWe used 2003–2012 data from Taiwan’s National Health Insurance Research Database to conduct this nationwide, population-based, case-control study. We identified AS patients newly diagnosed between 2005 to 2012 as the study group and selected age, sex and index-year matched (1:6) non-AS individuals as controls. The association between tonsillitis and risk of newly diagnosed AS was determined by calculating odds ratios (ORs) with 95% confidence intervals (CIs) using conditional logistic regression analysis.ResultsWe identified 37,002 newly diagnosed AS cases and 222,012 matched non-AS controls. Patients with AS were more likely to have tonsillitis (aOR 1.46, 95% CI 1.43–1.50), appendicitis (aOR 1.29, 95% CI 1.13–1.48) and periodontitis (aOR 1.35, 95% CI 1.31–1.38) than non-AS control subjects. The association between tonsillitis and AS was consistent using varying definitions for tonsillitis, and we further found that a high frequency of visits for tonsillitis, a high medical cost for tonsillitis and a long interval between diagnosis were associated with newly diagnosed AS in a dose-response manner. Furthermore, the association between tonsillitis and AS appeared to be stronger in females (aOR 1.59, 95% CI 1.53–1.65) than those in males (aOR 1.39, 95% CI 1.35–1.44).ConclusionsThe present study revealed an association between AS risk and prior tonsillitis and indicates the need for vigilance of AS-associated symptoms in patients who had been diagnosed with tonsillitis, particularly in females.
Highlights
Ankylosing spondylitis (AS), an autoimmune arthritis, is characterized by a dysregulated inflammation involving mainly the sacroiliac joints, axial structure, and enthesis [1]
Tonsillitis and ankylosing spondylitis varying definitions for tonsillitis, and we further found that a high frequency of visits for tonsillitis, a high medical cost for tonsillitis and a long interval between diagnosis were associated with newly diagnosed AS in a dose-response manner
The association between tonsillitis and AS appeared to be stronger in females than those in males
Summary
Ankylosing spondylitis (AS), an autoimmune arthritis, is characterized by a dysregulated inflammation involving mainly the sacroiliac joints, axial structure, and enthesis [1]. The exact mechanisms underlying AS remains unknown, and genetic predisposition including HLA-B27, gut dysbiosis, and environmental triggers including acute infectious diseases have been implicated in the pathogenesis of AS [3,4,5]. Tonsillitis is a leading disease in otolaryngology, and the admission for tonsillitis was found to rise by 310% between 2003 and 2011 in the United Kingdom [6, 7]. Tonsillitis has recently been implicated in the development of autoimmune arthritis including reactive arthritis and rheumatoid arthritis (RA), and gut dysbiosis appears to play an essential role in the linkage between infectious diseases and autoimmune arthritis [8,9,10]. We aimed to address the correlation between infectious diseases including tonsillitis and the newly diagnosed AS using a nationwide, population-based claim database
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