Autoimmune diseases and malignancies in patients with thymoma: A 9-year retrospective study.

Introduction Individuals with one autoimmune disease are at risk of developing a second autoimmune disease, but the pathogenesis or the sequential occurrence of multiple autoimmune diseases has not been established yet. In this study, we explored the association and sequential occurrence of antibodies in thyroid disease and systemic autoimmune disease subjects. We evaluated thyroid hormones, thyroid-stimulating hormone (TSH), free thyroxine (FT4), thyroid autoantibodies, anti-thyroperoxidase (anti-TPO), and anti-thyroglobulin (Tg) to comprehend the association with systemic autoimmune autoantibodies, anti-nuclear antibodies (ANA), and autoantibodies to extractable nuclear antigens (ENA) in subjects with thyroid-related symptoms. Methods A total of 14825 subjects with thyroid-related symptoms were tested at Vibrant America Clinical Laboratory for thyroid markers (TSH, FT4, anti-TPO, and anti-Tg) and an autoimmune panel (ANA panel and ENA-11 profile) from March 2016 to May 2018. Thyroid-positive (based on TSH and FT4 levels), anti-TPO-positive, and anti-Tg-positive subjects were assessed for the prevalence of ANA and anti-ENA antibodies. A 2-year follow-up study was conducted to assess the sequential order of appearance of autoimmune markers in thyroid and systemic autoimmune diseases. Results In the retrospective analysis, 343/1671 (20.5%), 2037/11235 (18.1%), and 1658/9349 (17.7%) of thyroid+, anti-TPO+, and anti-Tg+ subjects were found to be seropositive for ANA. Anti-ENA was detected in a higher prevalence than ANA with 475/1671 (28.4%), 3063/11235 (27.3%), and 2511/9349 (26.9%) in the same groups of subjects, respectively. Our results are found to be much higher than the reported prevalence of anti-ENA in general population. During the 2-year follow-up study, anti-TPO appeared significantly earlier than ANA and anti-ENA in an average of 253 (±139) and 227 (±127) days, respectively. Conclusions A high prevalence of anti-ENA and ANA was found to be coexisting with autoimmune thyroid disease subjects, with anti-TPO occurring prior to the onset of ANA and anti-ENA. Therefore, frequent follow-ups and evaluation of ANA and anti-ENA in subjects with anti-TPO positivity would be beneficial in early detection of other systemic autoimmune diseases.

De novo autoimmune hepatitis after liver transplantation

Background:In patients with the antiphospholipid syndrome (APS), concomitant systemic autoimmune rheumatic diseases (SARD) are common and often associated with more disease associated damage.Less is known about the prevalence of non-rheumatic...

To investigate for the risk of uveitis among such patients. A retrospective cohort study utilized the TriNetX database and recruited pediatric autoimmune patients diagnosed between January 1st 2004 and December 31st 2022. The non-autoimmune cohort were randomly selected control patients matched by sex, age, and index year. The main outcome is the incidence of new-onset uveitis. 175,328 pediatric patients with autoimmune diseases (mean age 10.7 +/- 5.1 years; 55.8% female; 66.2% White) and 175,328 pediatric patients without autoimmune diseases (mean age 10.8+/- 5.1 years; 55.7% female; 66% White) were recruited. The autoimmune cohort demonstrated a significantly increased uveitis risk across our 18-year study period (HR 4.42 [95% CI 3.98–4.90]). Iridocyclitis, chorioretinal inflammation, unspecified purulent endophthalmitis, panuveitis, retinal vasculitis, and sympathetic uveitis were uveitis conditions significantly associated with autoimmune diseases. Autoimmune patients who had used immunosuppressant medications had increased uveitis risk compared to those who had never used immunosuppressants. Our subgroup analysis also demonstrated a significantly increased uveitis risk associated with specific autoimmune conditions. Conditions include inflammatory arthritis, systemic autoimmune rheumatic diseases, systemic vasculitis, inflammatory bowel disease, psoriasis, multiple sclerosis, and immune thrombocytopenic purpura. Using hazard ratios HR for comparison, we were able to identify that, out of the previously broadly defined category of autoimmune diseases, only these specific conditions were significantly associated with pediatric uveitis. Uveitis was significantly associated with autoimmune diseases among the pediatric population.

First-Degree Living-Related Donor Liver Transplantation in Autoimmune Liver Diseases.

To investigate preterm birth (PTB) phenotypes in women with different autoimmune rheumatic diseases in a large population-based cohort. Retrospective cohort study. California, USA. All live singleton births in California between 2007 and 2011 were analysed. Patients with autoimmune disease at delivery were identified by International Classification of Diseases, Ninth Revision , Clinical Modification (ICD-9-CM), codes for systemic lupus erythematosus (SLE), systemic sclerosis (SSc), rheumatoid arthritis (RA), polymyositis/dermatomyositis (DM/PM), and juvenile idiopathic arthritis (JIA). Maternally linked hospital and birth certificate records of 2481516 deliveries were assessed (SLE n=2272, RA n=1501, SSc n=88, JIA n=187, DM/PM n=38). Multivariable Poisson regression models estimated the risk ratios (RRs) for different PTB phenotypes (relative to term deliveries) for each autoimmune disease compared with the general obstetric population, adjusting for maternal age, race/ethnicity, body mass index, smoking, education, payer, parity, and prenatal care. Preterm birth (PTB) was assessed overall (20-36weeks of gestation) and by subphenotype: preterm prelabour rupture of membranes (PPROM), spontaneous birth, or medically indicated PTB. The risk of PTB overall and for each phenotype was partitioned by gestational age: early (20-31weeks of gestation) and late (32-36weeks of gestation). Risks for PTB were elevated for each autoimmune disease evaluated: SLE (RR 3.27, 95%CI 3.01-3.56), RA (RR 2.04, 95%CI 1.79-2.33), SSc (RR 3.74, 95%CI 2.51-5.58), JIA (RR 2.23, 95%CI 1.54-3.23), and DM/PM (RR 5.26, 95%CI 3.12-8.89). These elevated risks were observed for the majority of PTB phenotypes as well. Women with systemic autoimmune diseases appear to have an elevated risk of various PTB phenotypes. Therefore, preconception counselling and close monitoring during pregnancy is crucial. This study found that women with systemic autoimmune diseases have an elevated risk of preterm birth phenotypes.

BackgroundAutoimmune polyendocrinopathy syndromes (APS) include heterogeneous clinical conditions characterized by functional alterations of at least one endocrine gland associated with other autoimmune diseases.APS-1 is a rare disease due to gene...

BackgroundAutoimmune polyendocrine syndromes (APS) are a heterogeneous group of clinical conditions characterized by functional alteration of one or more endocrine glands and often associated with other systemic autoimmune diseases. Four...

Purpose The association between autoimmune diseases and keratoconus (KC) has been proposed based on previous retrospective studies and case reports. The aim of our study is to investigate whether KC is associated with autoimmune thyroid disease. Methods. A comparative study was conducted on 131 adult subjects from September 2015 to May 2017 at Jordan University Hospital, Amman, Jordan. Subjects were classified into 2 groups: subjects with autoimmune thyroid disease, including Graves' disease and Hashimoto's thyroiditis (n = 68), and a healthy group for comparison (n = 63). Subjects with any other conditions known to be associated with KC were excluded. The diagnosis of KC was based on clinical and corneal topographic findings utilizing the Oculus-Pentacam machine. In addition, TSH and total T4 levels as well as thyroid peroxidase antibodies were measured in all study participants. Antithyroglobulin antibodies, thyroid stimulating immunoglobulin, thyroid ultrasound, and thyroid uptake and scan were also selectively performed in some participants. Results This study included a total of 131 participants (101 females and 30 males), including patients and controls. In the multivariate analysis, autoimmune disease was not significantly associated with keratoconus (OR = 1.1; 95% confidence interval: 0.3, 3.8; p value = 0.353) after adjusting for age and gender. Conclusion This study did not show a statistically significant association between autoimmune thyroid disease and KC.

The risk of fractures is higher in patients with autoimmune diseases, but it is not clear whether the use of immunosuppressive agents can further increase this risk. To investigate this issue, a retrospective study was conducted using data from Taiwan's National Health Insurance Research Database. Patients diagnosed with autoimmune diseases between 2000 and 2014, including psoriatic arthritis, rheumatoid arthritis, ankylosing spondylitis, and systemic lupus erythematosus, were included in the study. A control group of patients without autoimmune diseases was selected from the same database during the same period. Patients with autoimmune diseases were divided into two sub-cohorts based on their use of immunosuppressive agents. This study found the risk of fractures was 1.14 times higher in patients with autoimmune diseases than in those without. Moreover, we found that patients in the immunosuppressant sub-cohort had a higher risk of fractures compared to those in the non-immunosuppressant sub-cohort. The adjusted sub-distribution hazard ratio for shoulder fractures was 1.27 (95% CI = 1.01-1.58), for spine fractures was 1.43 (95% CI = 1.26-1.62), for wrist fractures was 0.95 (95% CI = 0.75-1.22), and for hip fractures was 1.67 (95% CI = 1.38-2.03). In conclusion, the long-term use of immunosuppressive agents in patients with autoimmune diseases may increase the risk of fractures.

Omalizumab is a preferred treatment in antihistamine-refractory chronic spontaneous urticaria (CSU) patients. However, factors that may impact treatment response remain to be explored. This study aimed to examine the factors affecting treatment response in CSU patients receiving omalizumab. This was a retrospective study that included 123 patients who received omalizumab treatment for CSU between January 2015 and April 2024. After administering omalizumab, we evaluated therapeutic efficacy with the urticaria control test (UCT). According to UCT, patients were classified as complete responders, partial responders, and nonresponders. The median age of the patients was 42 (31-50) years, and there were 77 (62.9%) female patients. Sixty-four (52%) patients exhibited complete response, and 43 (35%) patients exhibited partial response to omalizumab treatment, whereas 16 (13%) patients were nonresponders. Autoimmune disease (AID) was present in 31 (25.2%) patients. The most common AID was thyroid autoimmunity, seen in 24 (77.4%) patients. AID was significantly higher in omalizumab treatment nonresponders than in partial and complete responders. The presence of an autoimmune thyroid disease was an independent risk factor for failure to respond to omalizumab treatment. Baseline IgE levels were significantly higher in omalizumab treatment responders with a complete response compared to those with a partial response and nonresponders. Response to omalizumab treatment was influenced by the presence of an AID and baseline serum total IgE level. A concurrent autoimmune thyroid disease was found to be an independent risk factor affecting failed treatment response. Factors that can predict response to omalizumab treatment can help guide patients to more effective treatment.

Background: Omalizumab is a preferred treatment in antihistamine-refractory chronic spontaneous urticaria (CSU) patients. However, factors that may impact treatment response remain to be explored.Objective: This study aimed to examine the factors affecting treatment response in CSU patients receiving omalizumab.Methods: This was a retrospective study that included 123 patients who received omalizumab treatment for CSU between January 2015 and April 2024. After administering omalizumab, we evaluated therapeutic efficacy with the urticaria control test (UCT). According to UCT, patients were classified as complete responders, partial responders, and nonresponders.Results: The median age of the patients was 42 (31–50) years, and there were 77 (62.9%) female patients. Sixty-four (52%) patients exhibited complete response, and 43 (35%) patients exhibited partial response to omalizumab treatment, whereas 16 (13%) patients were nonresponders. Autoimmune disease (AID) was present in 31 (25.2%) patients. The most common AID was thyroid autoimmunity, seen in 24 (77.4%) patients. AID was significantly higher in omalizumab treatment nonresponders than in partial and complete responders. The presence of an autoimmune thyroid disease was an independent risk factor for failure to respond to omalizumab treatment. Baseline IgE levels were significantly higher in omalizumab treatment responders with a complete response compared to those with a partial response and nonresponders.Conclusion: Response to omalizumab treatment was influenced by the presence of an AID and baseline serum total IgE level. A concurrent autoimmune thyroid disease was found to be an independent risk factor affecting failed treatment response. Factors that can predict response to omalizumab treatment can help guide patients to more effective treatment.

Most cases of chronic urticaria (CU) are idiopathic. Circumstantial evidence suggests that some CU cases have an autoimmune pathogenesis. Previous research indicates that a substantial percentage of patients with CU have an atopic background. This study aims to examine the association between CU, and atopic and autoimmune diseases. This population-based retrospective cohort study identified 9,332 patients with CU and 37,328 controls matched for age, sex, and number of dermatological clinic visits from the Taiwan National Health Insurance Research Database for 2004-2009. Using multiple logistic regression, we estimated odds ratios (OR) and 95% confidence intervals (CI) for associations of CU with atopic and autoimmune diseases. CU was most strongly associated with Kawasaki disease (modified OR, 2.76; 95% CI 1.15-6.63), followed by Henoch-Schönlein purpura (HSP), atopic dermatitis (AD), systemic lupus erythematosus (SLE), allergic rhinitis (AR), autoimmune thyroid diseases, Sjögren syndrome, inflammatory bowel disease (IBD), and asthma, which had the lowest adjusted OR (1.11; 95% CI 1.01-1.22) among comorbidities significantly associated with CU. The associations varied in relation to age, group, and sex. Among women, CU was significantly associated with AD, AR, autoimmune thyroid diseases, SLE, vitiligo, and HSP. Among men, CU was significantly associated with AD, AR, autoimmune thyroid diseases, Kawasaki disease, and IBD. CU is associated with atopic/autoimmune diseases. Increased awareness of atopic and autoimmune comorbidities may be warranted for patients with CU.

This study aimed to determine the frequency of autoimmune diseases (ADs) accompanying common variable immunodeficiency (CVID) and evaluate clinical and immunological features, organ manifestation, and effects on malignancy and mortality. The retrospective study was conducted with 85 patients (47 males, 38 females; median age: 38 years; range, 30 to 53 years) with CVID between January 2013 and January 2023. The patients were divided into two groups according to the presence of ADs: CVID patients with ADs [AD-CVID (+) group; n=36] and CVID patients without ADs [AD-CVID (-) group; n=49]. The clinical and immunological features of the groups were compared, and the effects on organ manifestations, malignancy development, and mortality were evaluated. The diagnostic delay in the AD-CVID (+) group was 84 months and was longer than that in the AD-CVID (-) group. The most common AD was cytopenia, particularly immune thrombocytopenic purpura. Splenomegaly was the most common organ manifestation. Sjögren syndrome was the most common rheumatic disease. There was no difference between the immunoglobulin levels and lymphocyte subgroup levels, whereas the class-switched memory B cell levels were lower in the AD-CVID (+) group. While malignancy, particularly non-Hodgkin lymphoma, was more common in the AD-CVID (+) group, no difference was observed in mortality between the groups. Adult CVID patients with ADs have a longer diagnostic delay. Autoimmune conditions, particularly autoimmune cytopenias and inflammatory diseases, are much more common in patients with CVID than in the general population. Therefore, physicians' awareness of autoimmune manifestations in CVID patients should be increased to prevent delays in diagnosis.

Patients with an autoimmune disease could be at higher risk of a poor outcome when contracting COVID-19 infection due to aberrant immune responses and use of immunosuppressant therapies for chronic autoimmune treatment. Here, we conducted a retrospective study to identify the factors related to severity, hospitalization, and mortality among patients with autoimmune diseases. We found 165 cases of patients with pre-existing autoimmune diseases who had contracted COVID-19 between March 2020 and September 2022. Data on demographical characteristics; autoimmune diagnosis and treatment; COVID-19 vaccination status; and time, severity, and outcome of COVID-19 infection were collected. Most of the subjects were female (93.3%) and autoimmune diagnoses included systemic lupus erythematosus (54.5%), Sjogren's syndrome (33.5%), antiphospholipid syndrome (23%), vasculitis (5.5%), autoimmune thyroid disease (3.6%), rheumatoid arthritis (3.03%), and inflammatory bowel disease (3.03%) among other autoimmune diseases. There were four COVID-19-related deaths in this study. Factors associated with moderate to severe COVID-19 infection in patients with autoimmune diseases included not being vaccinated against COVID-19, taking a steroid of ≥10 mg prednisone-equivalent per day, and having a cardiovascular disease. Taking a steroid of ≥10 mg prednisone-equivalent per day was also associated with hospitalization in the event of COVID-19 infection, while cardiovascular diseases also showed a significant correlation to mortality in patients with autoimmune diseases who had been hospitalized with COVID-19 infection.