Abstract
Objective: Primary Sjögren's syndrome (pSS) is characterized by exocrine glandular inflammation; however, the association between preceding mammary-gland-inflammation-related diseases and newly diagnosed pSS remains unexplored.Methods: We used the 2003–2013 data retrieved from Taiwan's National Health Insurance Research Database (NHIRD) to conduct the present population-based study. We identified newly diagnosed pSS female patients during the 2001–2013 period, as well as age-matched (1:20) and propensity-score-matched (1:2) non-SS individuals (as controls). We explored the associations between pSS and a history of mastitis and fibrocystic breast disease by determining adjusted odds ratios (aORs) with 95% confidence intervals (CIs) using a conditional logistical regression analysis after controlling for potential confounders.Results: We identified 9,665 patients with pSS and 193,300 age-matched non-SS controls, as well as 9,155 SS cases and 18,310 propensity-score-matched non-SS controls. We found that fibrocystic breast disease (aOR, 1.75; 95% CI, 1.63–1.88) were independently associated with incident SS, whereas mastitis and childbirth-associated breast infections were not associated with incident SS. We also found positive associations between SS and previously reported SS-associated diseases, including cardiovascular diseases, thyroid diseases, pancreatitis, bronchiectasis, infectious diseases, osteoporosis, and ankylosing spondylitis. In the propensity-score-matched populations, the associations between pSS and fibrocystic breast disease (aOR, 1.74; 95% CI, 1.58–1.91) remained consistent.Conclusion: The present population-based study revealed a previously unexplored association between pSS and history of fibrocystic breast disease, and the finding highlights the need to survey pSS in patients with mammary-gland-inflammation-associated diseases.
Highlights
Primary Sjögren’s syndrome is a highly prevalent autoimmune disease that affects approximately 1% of the general population and is characterized by chronic inflammation of exocrine glands, mainly of the salivary, lacrimal, and mammary glands [1,2,3,4]
Lactational mastitis appears to be an infectious disease among women of a young age, whereas non-lactational mastitis tends to be found in women older than 40 years and may be associated with autoimmune disease [6, 11]
In the age- and index-year-matched population compared with non-SS controls, we found that SS cases had a similar distribution of urbanization levels and a low probability to have a lower insured amount (47.5 vs. 50.2%, P < 0.01), and were more likely to have mastitis (2.7 vs. 1.8%, P < 0.01)
Summary
Primary Sjögren’s syndrome (pSS) is a highly prevalent autoimmune disease that affects approximately 1% of the general population and is characterized by chronic inflammation of exocrine glands, mainly of the salivary, lacrimal, and mammary glands [1,2,3,4]. Unlike numerous studies that have explored xerophthalmia and xerostomia in relation to pSS, the association between the inflammatory disease of mammary gland and pSS remains unclear [5, 6]. Fibrocystic breast change is a highly prevalent benign breast disease in both pre-menopausal and post-menopausal women; studies have found that fibrocystic breast change may lead to moderate-to-severe breast pain in nearly 10% of healthy women [7, 10]. Given that the majority of patients with pSS are older than 40 years at the time of diagnosis, there is a crucial need to address the association between the benign breast disease and the development of pSS. In the present population-based study, we used agematched, and propensity-score-matched study populations to investigate the association between the benign breast disease and pSS
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