Tseng Chia-Chun, Chang Shun-Jen, Tsai Wen-Chan, Ou Tsan-Teng, Wu Cheng-Chin, Sung Wan-Yu, Hsieh Ming-Chia, Yen Jeng-Hsien
Department of Internal Medicine (Tseng), Kaohsiung Municipal Ta-Tung Hospital; Department of Kinesiology (Chang), Health and Leisure Studies, National University of Kaohsiung; Division of Rheumatology (Tsai, Ou, Wu, Sung, Yen), Department of Internal Medicine, Kaohsiung Medical University Hospital; Graduate Institute of Medicine (Sung, Yen), College of Medicine, Kaohsiung Medical University; Division of Endocrinology and Metabolism, Department of Internal Medicine (Hsieh), Changhua Christian Hospital, Changhua, Taiwan; Graduate Institute of Integrated Medicine (Hsieh), China Medical University, Taichung, Taiwan.
Department of Internal Medicine (Tseng), Kaohsiung Municipal Ta-Tung Hospital; Department of Kinesiology (Chang), Health and Leisure Studies, National University of Kaohsiung; Division of Rheumatology (Tsai, Ou, Wu, Sung, Yen), Department of Internal Medicine, Kaohsiung Medical University Hospital; Graduate Institute of Medicine (Sung, Yen), College of Medicine, Kaohsiung Medical University; Division of Endocrinology and Metabolism, Department of Internal Medicine (Hsieh), Changhua Christian Hospital, Changhua, Taiwan; Graduate Institute of Integrated Medicine (Hsieh), China Medical University, Taichung, Taiwan
CMAJ. 2017 Feb 6;189(5):E187-E193. doi: 10.1503/cmaj.160783.
Although dermatomyositis and Sjögren syndrome share serologic autoantibodies and genetic polymorphisms, population data about the incidence of Sjögren syndrome in patients with dermatomyositis is unavailable. We performed a nationwide cohort study to explore the potential relation between dermatomyositis and Sjögren syndrome and, if an association exists, to elucidate whether it varies by sex.
We identified all patients with newly diagnosed dermatomyositis from the Registry of Catastrophic Illness Database in Taiwan between Jan. 1, 1998, and Dec. 31, 2011. Each patient was matched to, at most, 5 control patients from the National Health Insurance Research Database by age, sex and entry date. Cox regression was used to calculate the hazard ratio (HR) and 95% confidence interval (CI) of Sjögren syndrome after adjusting for age, sex, rheumatoid arthritis, systemic lupus erythematosus and systemic sclerosis.
A total of 1602 patients with dermatomyositis and 7981 control patients were enrolled in the study. There was a positive association of having Sjögren syndrome among patients with dermatomyositis after adjusting for age, sex, rheumatoid arthritis, systemic lupus erythematosus and systemic sclerosis (HR 2.67, 95% CI 2.01-3.54). The association was more pronounced in the male cohort (HR 2.69, 95% CI 1.19-6.09).
We found a sex differential association of Sjögren syndrome among patients with dermatomyositis independent of age and concomitant autoimmune disease. Further studies are required to determine the clinical importance of this association for both outcomes and therapeutic options.
尽管皮肌炎和干燥综合征存在血清学自身抗体和基因多态性，但关于皮肌炎患者中干燥综合征发病率的人群数据尚不可得。我们进行了一项全国性队列研究，以探讨皮肌炎与干燥综合征之间的潜在关系，若存在关联，则阐明其是否因性别而异。
我们从台湾重大伤病数据库登记处中识别出1998年1月1日至2011年12月31日期间新诊断的所有皮肌炎患者。根据年龄、性别和入组日期，将每位患者与来自国民健康保险研究数据库的至多5名对照患者进行匹配。在调整年龄、性别、类风湿关节炎、系统性红斑狼疮和系统性硬化症后，使用Cox回归计算干燥综合征的风险比（HR）和95%置信区间（CI）。
共有1602例皮肌炎患者和7981例对照患者纳入研究。在调整年龄、性别、类风湿关节炎、系统性红斑狼疮和系统性硬化症后，皮肌炎患者中患干燥综合征存在正相关（HR 2.67，95% CI 2.01 - 3.54）。该关联在男性队列中更为明显（HR 2.69，95% CI 1.19 - 6.09）。
我们发现皮肌炎患者中干燥综合征的关联存在性别差异，且独立于年龄和伴随的自身免疫性疾病。需要进一步研究来确定这种关联对于结局和治疗选择的临床重要性。
