Department of Internal Medicine, Division of Rheumatology, Allergy and Immunology, Kaohsiung Chang Gung Memorial Hospital and School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC.
College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan, ROC.
Int J Rheum Dis. 2024 Sep;27(9):e15289. doi: 10.1111/1756-185X.15289.
To investigate the psoriatic disease risk among patients with previous appendicitis.
This study was a nationwide population-based case-control study about the association between the psoriatic disease risk among patients with a history of appendicitis in Taiwan. The study population consisted of newly diagnosed psoriatic disease with at least two outpatient visits, and the control group included those patients without psoriatic disease at the same index date. Patients with a previous diagnosis of appendicitis or who underwent appendectomy surgery prior to their psoriatic disease diagnosis were recorded. The odds ratio of psoriatic disease diagnosis in the two groups with and without a history of appendicitis were analyzed and compared.
A total of 48 894 individuals diagnosed with psoriatic disease were matched with 292 656 controls by age and gender. Notably, the proportion of patients with a history of appendicitis or primary appendectomy was significantly elevated among those with psoriatic disease compared with the control cohort (both p < .05). On average, the occurrence of appendicitis preceded the index date by 3.3 ± 2.3 years. Multivariate analysis revealed a heightened incidence rate of psoriatic disease in patients previously diagnosed with appendicitis, periodontal disease, Charlson comorbidity index score (CCIS) ≧1, and ill-defined intestinal infections. This association persisted after adjusting for confounding factors, such as periodontal disease, CCIS, Salmonella, and ill-defined intestinal infections. The odds ratios for psoriatic disease in individuals with a history of appendicitis, periodontal disease, CCIS ≧1, and ill-defined intestinal infections were 1.16, 1.008, 1.69, and 1.23, respectively, with corresponding 95% confidence intervals of 1.03-1.31, 1.05-1.11, 1.65-1.74, and 1.20-1.26. These findings underscore the independent association between appendicitis and subsequent development of psoriatic disease, even after adjusting for relevant comorbidities and potential confounders.
Our research illustrates that appendicitis is associated with an increased likelihood of developing a psoriatic disease, despite several limitations. These limitations encompass variables such as dietary and smoking habits, alongside other potential confounding factors that were not fully considered. Moreover, inherent biases in utilizing national health insurance data, such as the absence of laboratory information, as well as the constraints inherent in a retrospective study design, should be acknowledged.
探讨既往阑尾炎患者发生银屑病的风险。
本研究是一项在台湾进行的全国性基于人群的病例对照研究，旨在探讨既往阑尾炎与银屑病发病风险之间的关系。研究人群包括至少两次门诊就诊的新发银屑病患者，对照组为同一索引日期无银屑病的患者。记录有既往阑尾炎诊断或在银屑病诊断前接受过阑尾切除术的患者。分析并比较两组中有无阑尾炎史的患者发生银屑病的比值比。
共纳入 48894 例银屑病患者和 292656 例对照，两组患者的年龄和性别相匹配。值得注意的是，与对照组相比，患有银屑病的患者中既往有阑尾炎或初次阑尾切除术的比例明显升高（均 P <.05）。平均而言，阑尾炎发生时间早于索引日期 3.3±2.3 年。多变量分析显示，既往诊断为阑尾炎、牙周病、Charlson 合并症指数（CCIS）≥1 以及原因不明的肠道感染的患者发生银屑病的发病率更高。在调整了牙周病、CCIS、沙门氏菌和原因不明的肠道感染等混杂因素后，这种关联仍然存在。既往有阑尾炎、牙周病、CCIS≥1 和原因不明的肠道感染的患者发生银屑病的比值比分别为 1.16、1.008、1.69 和 1.23，相应的 95%置信区间分别为 1.03-1.31、1.05-1.11、1.65-1.74 和 1.20-1.26。这些发现强调了阑尾炎与随后发生银屑病之间的独立关联，即使在调整了相关合并症和潜在混杂因素后也是如此。
尽管存在一些局限性，我们的研究表明阑尾炎与银屑病发病风险增加相关。这些局限性包括饮食和吸烟习惯等变量，以及其他未充分考虑的潜在混杂因素。此外，利用国家健康保险数据存在固有偏差，例如缺乏实验室信息，以及回顾性研究设计固有的限制，这些都应该得到承认。
