Abstract
Objectives To assess whether there are shared exposures associated with Sjogren's syndrome (SS), dry eye syndrome (DES), and B-cell non-Hodgkin lymphoma (B-NHL), in order to determine whether they are etiologically related. Methods In a clinic-based case-control study, 702 participants (91 SS, 120 DES, 211 (age and sex frequency-matched) controls, and 280 B-NHL cases) were recruited and interviewed regarding exposures, medical history, and family history. Results Female predominance was noted in SS (ratio 9.2 : 1). Eye dryness was severest in SS compared to DES and controls (P < 0.001). Compared to controls, alcohol consumption was inversely associated with NHL, DES, and SS (odds ratio (OR) = 0.47, 95% confidence interval (CI): 0.31-0.71; OR = 0.54, 95% CI: 0.33-0.88; and OR = 0.26, 95% CI: 0.14-0.49, respectively), while a previous history of infection requiring hospitalization was positively associated with all three conditions: NHL (OR = 1.92; 95% CI: 1.23-2.99), DES (OR = 3.29; 95% CI: 1.97-5.47), and SS (OR = 4.74; 95% CI: 2.66-8.44). NHL patients were more likely to report first-degree relatives with hematologic cancer, while having first-degree relatives with an autoimmune disease (AID) was associated with SS (OR = 5.25; 95% CI: 2.59-10.63) and DES (OR = 3.55; 95% CI: 1.83-6.91) compared to controls. Conclusions Some exposures are associated with all three conditions (such as an inverse association with alcohol consumption and a positive association with serious past infection), while a family history of AID appears to be shared by DES and SS, but not NHL subjects. Shared risk factors for all three conditions indicate possible mutual etiological pathways.
Highlights
In order to further our understanding of neoplastic transformation, it is important to understand the medical and environmental antecedents of disease
Priori and colleagues reported on a sevenfold increased odds ratios (ORs) for s syndrome (SS) in subjects with a first-degree relative with an autoimmune disease (AID) (OR = 7 4; 95% confidence intervals (CI): 2.8-20.1) [10], as compared to the fivefold increase we found in SS subjects and threefold in Dry eye syndrome (DES) subjects compared to controls
The hypothesis that SS may begin as DES and develop into B-cell non-Hodgkin lymphoma (B-NHL) was not fully supported by the study findings, but we found shared exposures and risk factors to these diseases compared to healthy controls, suggesting that chronic inflammation and autoimmunity may be at the basis of this continuum
Summary
In order to further our understanding of neoplastic transformation, it is important to understand the medical and environmental antecedents of disease. Other risk factors associated with DES are African-American ethnicity [1], medical conditions such as diabetes (mainly type 2), autoimmune conditions, noninflammatory arthritic conditions, thyroid diseases, sleep apnoea [1, 3], and posttraumatic stress disorder (PTSD) [1]. Medications such as antihistamines, antianxiety, and antidepressants have been implicated [1]. Alcohol consumption was found to have a protective effect on AIDs such as systemic lupus erythematosus (SLE) [12], but this effect has not been reported in relation to SS
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