Abstract
Helicobacter pylori (HP) infection is associated with systemic lupus erythematosus (SLE), but the related results have been controversial. Therefore, this study investigated the association between HP infection and SLE by using a nationwide longitudinal population-based cohort. We identified 41,651 patients with HP infection and 83,302 matched controls between 2000 and 2013 from the Longitudinal Health Insurance Research Database of the National Taiwan Insurance Research Database. Age, gender, comorbidities, and medical visits were matched at a 1:2 ratio by using propensity score analysis. The adjusted hazard ratio (aHR) of SLE was calculated by multiple Cox regression. Furthermore, sensitivity test and stratified analysis were performed. The SLE incidence rate was 1.17 [95% confidence interval (CI): 0.89–1.54] per 100,000 person-months in the HP cohort, and the hazard ratio was 1.63 (95% CI: 1.12–2.37) in comparison with the propensity score-matched control cohort. After multivariate adjustment, patients with HP infection had a significantly high overall aHR (1.58; 95% CI: 1.08–2.30) of SLE. Stratified analysis revealed the aHR of 8.23 (95% CI: 1.77–38.32) in patients <30 years old, and the p for interaction between age and HP infection was 0.039. For age–sex subgroup analysis, the highest aHR was 12.74 (95% CI: 1.55–104.59) in young (aged <30 years) female patients with HP infection. HP infection is associated with a 1.63-fold increased SLE risk, particularly with female patients aged <30 years. Future research is required to elucidate the underlying mechanism of this association.
Highlights
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease of unclear etiology which can affect the skin, serous membranes, joints, heart, lungs, kidneys, nervous system, and other organs of the body
Since its discovery in 1982, Helicobacter pylori (HP) infection has been recognized as the main cause of chronic gastritis, peptic ulcer disease, stomach cancer, and mucosa-associated lymphoid tissue lymphoma, and it has been related with extragastric disorders including iron deficiency anemia, vitamin B12 deficiency, neurodegenerative disorders, and metabolic syndrome [12, 13]
A significant increase was observed in SLE risk in patients with HP infection [adjusted hazard ratios (HRs): 1.58, 95% confidence interval (CI): 1.08–2.30, Table 3]
Summary
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease of unclear etiology which can affect the skin, serous membranes, joints, heart, lungs, kidneys, nervous system, and other organs of the body. Since its discovery in 1982, HP infection has been recognized as the main cause of chronic gastritis, peptic ulcer disease, stomach cancer, and mucosa-associated lymphoid tissue lymphoma, and it has been related with extragastric disorders including iron deficiency anemia, vitamin B12 deficiency, neurodegenerative disorders, and metabolic syndrome [12, 13]. It may be associated with various autoimmune pathogeneses, such as Sjogren’s syndrome, rheumatoid arthritis, primary immune thrombocytopenia, autoimmune gastric atrophy, and autoimmune thyroiditis. Evidence exists that it may prevent the development of autoimmune diseases, such as SLE, autoimmune gastritis, multiple sclerosis, and inflammatory bowel diseases [8, 14, 15]
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