Prevalence Of Other Autoimmune Diseases Research Articles

Family aggregation and prevalence of other autoimmune diseases in SAPHO syndrome

ObjectiveSAPHO (Synovitis, Acne, Pustulosis, Hyperostosis and Osteitis) syndrome is a heterogeneous disease that clinically manifests as chronic inflammatory osteoarticular and dermatological lesions. Few reports have described familial clustering of SAPHO syndrome cases. This research aimed to illustrate the family aggregation of SAPHO syndrome and investigate the prevalence of autoimmune disorders among SAPHO syndrome patients and first-degree relatives in a large cohort. MethodsWe retrospectively reviewed the medical records of 233 SAPHO patients diagnosed at Peking Union Medical College Hospital. Direct phone calls were made to each first-degree relatives. All relatives of the patients who reported SAPHO syndrome were asked for a detailed outpatient evaluation. ResultsA total of 233 patients and 1227 first-degree relatives were recruited. Six (2.6 %) patients had positive SAPHO family history, including four mother-daughter pairs and two sister pairs. Twenty-one (9.0 %) patients presented at least one kind of autoimmune disease, including 12 rheumatoid arthritis and 4 ulcerative colitis cases. Fifty-eight (24.9 %) SAPHO syndrome patients had 68 (5.5 %) first-degree relatives with at least one autoimmune disorder. The palmoplantar pustulosis, psoriasis vulgaris, and rheumatoid arthritis prevalence in our subjects were each higher than reference rates. ConclusionThis is the first evaluation of familial aggregation for SAPHO syndrome in a large cohort. SAPHO syndrome has a weak familial aggregation. There is a relatively high prevalence of coexisting autoimmune disease among patients with SAPHO syndrome and their first-degree relatives. These results would prompt physicians to screen SAPHO syndrome patients and their family members for concomitant autoimmune diseases. KeypointsThis study suggesting a potential genetic component in the pathogenesis of SAPHO syndrome. This study is the first to evaluate the family aggregation of SAPHO syndrome in a large cohort.

Rare case of double seronegative ocular myasthenia gravis and non-functional pituitary macroadenoma

Chronic autoimmune neuromuscular disorder known as Myasthenia Gravis (MG). The relationship of myasthenia gravis with pituitary adenomas is relatively uncommon, despite the fact that it is widely known that people with the condition have a higher prevalence of other autoimmune diseases. Here, we describe the case of a 45-year-old Indian man who had complained of severe cephalgia, associated with ocular pain, dizziness, diplopia, ptosis of the unilateral right eye. Although he has a history of severe headaches that started prior to 3 months, his complaints became more obvious at the end of the day. An MRI of the brain revealed an increased pituitary gland that measured 13.7 × 15.5 x 16. 9 mm. Furthermore, post admission histological examinations supported the diagnosis of a double seronegative ocular myasthenia gravis and non-functional pituitary macroadenoma. Following treatment, it was discovered that Pyridostigmin and Prednisolone considerably reduced his myasthenia symptoms. Finally, it should be noted that pituitary tumours are one potential underlying cause of headache in myasthenic patients.

Prevalence of thyroid dysfunction and anti-thyroid peroxidase antibodies in vitiligo patients

<p class="abstract"><strong>Background:</strong> Vitiligo is associated with various autoimmune diseases, including autoimmune thyroid disease. The objectives of the present study was to determine the prevalence of thyroid dysfunction and anti-thyroid peroxidase antibodies in patients with vitiligo, and to compare the clinical profile of anti-thyroid peroxidase positive and anti-thyroid peroxidase negative patients<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> A cross-sectional comparative study was conducted in 100 patients with vitiligo and 100 controls. After dermatologic and systemic evaluation, serum thyroid hormones and anti-thyroid peroxidase antibody levels were measured in all the subjects.<strong></strong></p><p class="abstract"><strong>Results:</strong> Thyroid dysfunction was more common in the vitiligo group (27%) than in the controls. Serum thyroid stimulating hormone abnormalities were more common in the vitiligo group (27%) than in the controls (6%). The most common thyroid dysfunction was subclinical hypothyroidism. Anti-thyroid peroxidase antibody positivity was higher in the vitiligo group (36%) when compared to the controls (24%), and the most common type of vitiligo was vitiligo vulgaris (18%) in this group. Thyroid dysfunction and anti-thyroid peroxidase positivity were more common in women (58%) when compared to men (42%). There was a significantly higher prevalence of other autoimmune diseases in the vitiligo group (20%) compared to the controls (6%)<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> This study shows a significant association between vitiligo and thyroid dysfunction, anti-thyroid peroxidase antibodies and other autoimmune diseases. We recommend that thyroid evaluation and regular follow-up should be done in patients with vitiligo for prompt detection of thyroid dysfunction<span lang="EN-IN">.</span></p>

Concomitant multiple sclerosis and another autoimmune disease: Does the clinical course change?

ObjectivesMultiple Sclerosis is a demyelinating disease that can cause different symptoms by the autoimmune involvement of myelin. CD4+ and CD8+ T-cells as well as B-cells play important roles in MS pathophysiology. Co-existence of other autoimmune diseases and multiple sclerosis has been reported previously in the literature. It is not clear whether this co-existence may change the clinical course of MS or not. In this study we aim to evaluate the prevalence of other autoimmune diseases among patients with MS and if they may play any role in the clinical course of the patients. Patients and methodsTwenty four patients with multiple sclerosis and another simultaneous autoimmune disease were detected among 1700 patients referred to the MS clinic of Sina Hospital during two years. Sex, age, duration of MS and the autoimmune disease as well as the type of the latter were recorded. For evaluation of disease progression a control group was randomly selected from the same patients referred to the clinic. EDSS was measured and recorded in both groups. ResultsThe prevalence of concomitant autoimmune disease and multiple sclerosis was 0.014. The mean age of the patients was 35.04±6.45years. There were 18 different autoimmune diseases in the first group. The mean duration of MS and concomitant autoimmune disease were 5.91 and 9.80±7.1years respectively. The mean of EDSS in these patients was 1.62±1.12 and in the control group was 3.33±1.89. One patient had developed secondary progressive course in the first group. The statistical difference between these groups based on EDSS, was significant (P-value: <0.001). The median of EDSS in the first group was 1.5 and in the second one was 2.5. The mean of annual relapse rate in the first group was 0.60 and in the second one was 0.62 (P-value: 0.71). ConclusionThe present study shows that several other autoimmune diseases may coexist with MS and their presence may modify the course of the disease. This should be re-evaluated in multicenter prospective long term studies.

Celiac disease and autoimmune thyroid diseases

Celiac disease (CD) is a disease that characterized with small intestinal injury by the ingestion of gluten, the major protein of wheat and similar grains in genetically predisposed persons. The clinical presentation may be seen in a wide spectrum from severe malabsorption syndromes to silent asymptomatic cases. Diagnosis of celiac disease requires the finding of a typical mucosal lesion from small bowel biopsy such as villous atrophy and crypt hypertrophy and recovery of the histological findings and clinical improvement after introduction of gluten free diet. The occurrence of antibodies supports the diagnosis of celiac disease. Prevalence of other autoimmune diseases, including autoimmune thyroid diseases, has been reported to be higher than controls. The coexistence of autoimmune thyroid disease and celiac disease may related to genetic predisposition. Thus evaluation of CD patients for thyroid disorders may improve CD patients’ quality of life and may be important in their clinical management. Patients diagnosed with autoimmune diseases may develop other autoimmune disorders related with different organ systems in consequent years. Clinicians should be aware of this issue and evaluate patients’ for concomitant endocrinopathies.

PATIENTS WITH SYSTEMIC SCLEROSIS ASSOCIATING OTHER AUTOIMMUNE DISEASES HAVE A MILDER DISEASE COURSE

Background and objectives. Systemic sclerosis (SSc) is a multisystem connective tissue disease (CTD), being one of the most heterogeneous diseases of the spectrum of CTDs. It may associate other autoimmune diseases (AIDs), therefore in this study we aimed to evaluate the prevalence of other AIDs in a cohort of patients with SSc and to evaluate their prognosis in comparison to patients with SSc without this association. Patients and methods. We performed a retrospective study in patients with SSc satisfying the ACR 1980 or the ACR/EULAR 2013 criteria, who were evaluated between January 2005 and May 2014 in our SSc center. These patients were investigated according to the EUSTAR recommendations, including modified Rodnan Skin Score (mRSS), lung function tests (LFT), echocardiography etc. As a control group for evaluating the prevalence of the AIDs we used all patients with Rheumatoid Arthritis (RA) visiting our clinic between January-December 2005. Data of all RA patients were collected from the electronic database of the hospital. All AIDs mentioned in the discharge diagnoses were recorded. Between-group comparisons were made with the chi-square test for nominal variables and with the independent-sample t-test for numeric variables. Results. 144 patients with SSc were included: 88.8% females, 66.6% with the limited cutaneous subset of disease (lcSSc), mean age 53.9 ± 12.8 years, mean disease duration at study enrollment 5.1±10.5 years and a mean follow-up time of 3.7 ± 2.6 years. Prevalence of the AID in the SSc cohort was 19.4%, patients with lcSSc being more prone to associate other AID (p = 0.001). We noted a tendency towards less interstitial lung disease (p = 0.056) and less digital ulcers (p = 0.081) in patients with SSc and AIDs. Comparing skin involvement for each year of follow-up in patients with SSc with and without and AIDs we observed that the first tended to have lower and more stable values of the mRSS. Conclusion. Patients with SSc and AIDs tend to have a better outcome than the ones without this association. mRSS remains stable across the years in patients with SSc and AID, with lower values than the SSc patients.

Coeliac disease and risk for other autoimmune diseases in patients with Williams-Beuren syndrome.

BackgroundA higher prevalence of coeliac disease (CD) has been reported in patients with Williams-Beuren syndrome (WBS), though coexistence with other autoimmune diseases has not been evaluated.Objective: The aim of this study was to examine the prevalence of the more frequent autoimmune diseases and organ- and non-organ specific autoantibodies in WBS.MethodsWe longitudinally analysed 46 WBS patients to evaluate the prevalence and co-occurrence of the major autoantibodies and HLA typing for CD diagnosis. These data were compared with healthy age- and sex-matched controls and Down (DS) and Turner (TS) syndrome patients.ResultsCD was diagnosed in one (2.2%) WBS patient; this differed significantly from DS and TS (respectively, 10.5% and 9.4%; P < 0.005) but not from healthy controls (0.6%; P = NS). However, no patients with WBS showed anti-thyroid antibodies or other organ- and non-organ specific autoantibodies, which differed significantly from DS (respectively, 10.5% and 7.0%; P < 0.005) and TS (respectively, 9.4% and 9.3%; P < 0.005) patients but not from healthy controls (1.1% and 2.3%). The frequencies of CD-specific HLA-DQ heterodimers were not significantly higher than controls, even though the WBS patients more frequently carried the DQA1*0505 allele (57% vs. 39%; P < 0.05).ConclusionsCD may not be more frequent in patients with WBS. In fact, no evidence of a significantly higher prevalence of other autoimmune diseases or positivity of the main organ and non-organ specific autoantibodies was found in WBS, such as showed in the healthy controls and unlike by the patients with Turner or Down syndrome. This should prompt us to better understand the occurrence of CD in WBS. Other studies or longer follow-up might be useful to clarify this issue.

High prevalence of antinuclear antibodies in children with thyroid autoimmunity.

Background. Antinuclear antibodies (ANA) are a hallmark of many autoimmune diseases and can be detected many years before disease onset. Autoimmune thyroid diseases (AITD) are frequently associated with other organ- and non-organ-specific autoimmune disorders. Objectives. To assess the prevalence of ANA in pediatric patients with AITD and their clinical correlations. Methods. Ninety-three consecutive pediatric patients with AITD were enrolled (86 children with chronic lymphocytic thyroiditis and 7 with Graves' disease). ANA, anti-double DNA (anti-dsDNA) antibodies, anti-extractable nuclear antigen (anti-ENA), anti-cyclic citrullinated peptide antibodies (anti-CCP), and rheumatoid factor (RF) was obtained. Signs and symptoms potentially related to rheumatic diseases in children were investigated by a questionnaire. Results. ANA positivity was found in 66/93 children (71%), anti-ENA in 4/93 (4.3%), anti-dsDNA in 1/93 (1.1%), RF in 3/93 (3.2%), and anti-CCP in none. No significant differences were found between the ANA-positive and ANA-negative groups with respect to age, sex, L-thyroxine treatment, or prevalence of other autoimmune diseases. Overall, parental autoimmunity was found in 23%. Conclusions. ANA positivity was demonstrated in 71% of children with AITD. ANA positivity was not related to overt immune-rheumatic diseases. However, because the positivity of ANA can occur even many years before the onset of systemic autoimmune diseases, prospective studies are warranted.

Having a Pet Dog Reduces Risk for Childhood Atopic Dermatitis

Cody Chang May Help His Household Avoid Atopic Dermatitis The hygiene hypothesis was proposed in 1989 as a possible explanation for the rapidly increasing prevalence of atopic dermatitis (AD) and other allergic and autoimmune diseases in developed nations. This hypothesis posits that reduced exposure to infectious agents in early life alters immune system maturation. Findings on pet exposure and risk for (AD) in children are inconsistent. Therefore, …

Vitamin D status and concomitant autoimmunity in celiac disease.

To determine whether patients with celiac disease (CD) and low vitamin D levels also have a higher prevalence of other autoimmune diseases (AD) as compared with patients with normal vitamin D levels. Patients with CD carry a higher risk of other autoimmune disorders. Because of its immunoregulatory properties, vitamin D deficiency has been proposed in the pathogenesis of a variety of AD. Whether low vitamin D levels in patients with CD can predict concomitant AD is unknown. A retrospective cross-sectional study of 530 adult patients with CD and a 25-hydroxyvitamin D level on record at Columbia University Medical Center. One hundred thirty-three patients (25%) had vitamin D deficiency. The prevalence of AD was similar among those with normal vitamin D levels (11%), insufficiency (9%), and deficiency (12%, P=0.66). On multivariate analysis, adjusting for age of CD diagnosis and sex, vitamin D deficiency was not associated with AD (odds ratio, 1.35; 95% confidence interval, 0.62-2.95). The risk of psoriasis was higher in patients with vitamin D deficiency (7% vs. 3%, P=0.04). Vitamin D deficiency was more common in those who presented with anemia (39%) than in those who did not (23% P=0.002). Vitamin D deficiency in CD is common but does not predict AD. The risk of psoriasis is increased in vitamin D-deficient CD patients. Assessment of vitamin D seems to be a high-yield practice, especially in those CD patients who present with anemia.

Pituitary autoimmunity in patients with diabetes mellitus and other endocrine disorders

Pituitary autoimmunity is often found in association with other endocrine autoimmune or non-autoimmune diseases. Aim of the study was to assess the prevalence of serum pituitary antibodies (PitAb) in patients with Type 1 diabetes mellitus (T1DM) or Type 2 diabetes mellitus (T2DM). In this casecontrol study 111 patients with T1DM, 110 patients with T2DM, and 214 healthy controls were enrolled in a tertiary referral center. Pituitary, thyroperoxidase, thyroglobulin, 21-hydroxylase, and parietal cell antibodies were assessed in all cases. Endocrine function was further assessed by basal hormone measurement and by dynamic tests, as well as a pituitary magnetic resonance imaging (MRI) was performed in those patients found positive for PitAb. PitAb prevalence was higher in T1DM (4 out of 111, 3.6%) than in T2DM (0 out of 110, p=0.045) and in healthy subjects (1 out of 214, 0.5% p=0.029). Prevalence of other autoimmune diseases was significantly higher in patients with T1DM (45 out of 111, 40.5%) when compared with patients with T2DM (18 out of 110 T2DM, 16.3%, p<0.001). Patients with T1DM and PitAb positivity were found with a pituitary lesion at MRI in 2 cases and pituitary dysfunction in one case. A significant association between pituitary autoimmunity and T1DM was found, in particular in subjects with one or more other endocrine autoimmune diseases.

Familial autoimmunity: maternal parent-of-origin effect in juvenile idiopathic arthritis

Juvenile idiopathic arthritis (JIA) is an autoimmune (AI) disease characterized by chronic arthritis in children. Children with JIA have increased prevalence of other AI diseases. Furthermore, relatives of children with JIA have been shown to have an increased prevalence of AI diseases. Our objective was to determine if there were differences in the prevalence of AI diseases among maternal and paternal relatives of children with JIA. Information about AI diseases among all living first- and second-degree relatives was collected by structured interviews with families of 121 simplex JIA families, 23 multiplex JIA families, and 45 control families. Overall, the prevalence of AI diseases was significantly increased among maternal second-degree relatives of cases compared to that of maternal second-degree relatives of controls [14% vs. 4.3%; p < 0.001]. The prevalence of AI diseases among mothers of JIA cases was three times that of fathers [32.3% vs. 11.4%; p < 0.0001]. The prevalence of AI diseases among all maternal second-degree relatives of children with JIA was significantly higher than that of all paternal second-degree relatives [14% vs. 7.9%; p < 0.004]. Although additional paternal effects cannot be excluded, together these results demonstrate that maternal relatives of children with JIA have an increased prevalence of autoimmunity compared to paternal relatives, suggesting that there might be a maternal parent-of-origin effect in JIA.

Severe clinical onset of diabetes and increased prevalence of other autoimmune diseases in children with coeliac disease diagnosed before diabetes mellitus.

To analyse whether the time of diagnosis of coeliac disease with respect to the clinical onset of diabetes could differentiate subgroups of varying severity in patients with both diseases. We investigated 383 patients with Type I (insulin-dependent) diabetes mellitus for coeliac disease. Sex distribution, age at diagnosis of diabetes, prevalence of ketoacidosis at the onset of diabetes and prevalence of other autoimmune diseases were compared in patients. We divided these patients according to whether coeliac disease was diagnosed before (Group A, n=8) or after (Group B, n=24) diabetes onset and whether they had presented clinical symptoms of coeliac disease. Group C (n=351) included diabetic patients without coeliac disease. Out of 383 Type I diabetic patients we found 32 coeliac subjects (8.3%). There was a higher number of girls (p=0.003), but similar age and prevalence of ketoacidosis compared with Group C; 18.7% had a third autoimmune disorder. The higher number of girls was confirmed in Groups A and B in comparison to Group C (p=0.013), while higher prevalence of both ketoacidosis (p=0.009) and other autoimmune diseases (p=0.001) was found only in Group A. Compared with symptomatic patients, asymptomatic subjects in Group B had a lower number of girls, older age at diabetes onset, lower prevalence of ketoacidosis and no other associated autoimmune disease. A wide clinical spectrum characterises the association of coeliac disease and diabetes mellitus, with a severe clinical presentation (higher prevalence of ketoacidosis at the onset and occurrence of other autoimmune diseases) when coeliac disease is diagnosed before diabetes. Distinct phenotypes might imply the contribution of a peculiar genetic background.

Chronic idiopathic urticaria and its management

: Chronic urticaria is defined as the daily or almost daily occurrence of wheals for at least 6 weeks. This disorder affects 0.1% of the general population and is more common in females. Recently a subgroup of patients with chronic urticaria has been found to have circulating autoantibodies directed against the high-affinity IgE receptor (Fc∍RI) or against IgE antibodies. These “autoantibodies” are felt to play a role in mast cell histamine release. Urticaria patients with these circulating antibodies also have a higher prevalence of other autoimmune diseases. The management of patients with chronic urticaria is to identify and eliminate the underlying cause, however, an etiology for chronic urticaria is rarely identified. Thus the approach to treatment usually centers on the use of antihistamines initially with the addition of other immune modulating agents as necessary.