Hemophagocytic syndrome in elderly patients with underlying autoimmune diseases

In patients with autoimmune disease-associated hemophagocytic syndrome (AAHS), the clinical features may differ from hemophagocytic syndrome (HPS) of other etiologies, and new criteria for AAHS have been proposed. Since bone marrow (BM) circumstances are changed according to aging, here we reviewed retrospectively our cases with AAHS in elderly patients, including two systemic lupus erythematosus (SLE), three Evans syndrome, one rheumatoid arthritis (RA), one Hashimoto thyroiditis, and one autoimmune pancreatitis. Although only two SLE patients were diagnosed as HPS by the classical criteria, the remaining patients except one RA met the criteria for AAHS. Seven patients except one SLE patient showed good response to therapy and demonstrated positive autoantibodies to blood cells, lower serum ferritin levels, and increased erythroblastic islands in the BM. We consider the diagnosis of AAHS should be carefully made when macrophages phagocytosing blood cells are observed in BM smear without hyperferritinemia in elderly patients with autoimmune diseases.     

The effects of peripheral cold exposure on oesophageal motility in patients with autoimmune rheumatic diseases and raynaud's phenomenon

Summary The effects of peripheral cold exposure on oesophageal motility were studied in 14 patients with autoimmune rheumatic diseases. They were divided into two groups: 9 with and 5 without Raynaud's phenomenon. The statistical comparison of these two groups did not reveal any difference in the way they manometrically reacted during and after the cold exposure. We conclude that the oesophageal dysfunction in Raynaud's phenomenon may not be of neurogenic origin.     

Domain reactivity of autoantibodies to calpastatin in patients with systemic rheumatic diseases

Autoantibodies to calpastatin (endogenous inhibitor of calpain, a calcium-dependent neutral proteinase) have been detected in sera of patients with rheumatoid arthritis (RA) and other diseases. We investigated the epitope reactivity of anticalpastatin autoantibodies in patients with rheumatic diseases. cDNAs encoding each calpastatin domain (L, I, II, III, and IV) were amplified by PCR and ligated into an expression vector. The fusion proteins were expressed in E. coli. The presence of autoantibodies specific for each calpastatin domain was assayed in sera of patients with various rheumatic diseases by immunoblotting the fusion proteins with these sera. Of the RA patient sera, 81% reacted with at least one calpastatin domain. This reaction was significantly greater than with sera from patients with systemic lupus erythematosus (46%), scleroderma (32%), polymyositis/dermatomyositis (43%), and normal controls (13%). Domains I and II were recognized by RA patient sera significantly more than by other patient sera, whereas domains III and IV reacted almost equally among all patient sera. Although, collectively, sera from RA and lupus patients reacted equally with all domains, scleroderma sera tended to react with only domains I and IV and myositis sera tended to recognize only domains III and IV. Patients with RA positive for anticalpastatin antibodies exhibited more active disease (i.e., a higher erythrocyte sedimentation rate and C-reative protein level) than antibody-negative patients. Our results suggest that anticalpastatin antibodies were detected in RA with the highest frequency and that different domain reactivity was shown among different diseases. The presence of these antibodies in sera may be related to the type of disease and, in RA, with disease activity, suggesting their importance in rheumatic disorders. Received: September 11, 1999 / Accepted: November 20, 1999     

免疫吸附治疗对自身免疫性疾病的疗效及安全性探讨

目的探讨免疫吸附治疗对自身免疫性疾病的疗效及安全性。方法选取2014-05~2015-07期间收治的自身免疫性疾病患者16例,其中系统性红斑狼疮(SLE)15例,抗肾小球基底膜(GBM)抗体患者1例,使用HA280或DNA230进行免疫吸附治疗,检测患者治疗前后ANA、ds-DNA、抗GBM抗体、Ig A、Ig G、Ig M、C3、C4及生化指标的变化。结果 9例SLE患者使用HA280免疫吸附后ANA、ds-DNA下降(P0.05),6例SLE患者使用DNA230免疫吸附后ds-DNA明显下降(P0.05),抗GBM病患者使用HA280连续免疫吸附治疗后抗GBM抗体转阴。所有患者治疗前后血常规及其他生化指标差异无统计学意义(P0.05)。结论免疫吸附治疗可有效清除自身免疫性抗体,对自身免疫性疾病治疗有效,无明显不良反应,安全性好。     

自身免疫性肝炎和原发性胆汁性肝硬化患者自身免疫性甲状腺疾病流行率调查*

目的 调查自身免疫性肝病(AILD)患者自身免疫性甲状腺疾病(AITD)发病率情况。 方法 2018年6月～2020年12月我院诊治的自身免疫性肝炎(AIH)41例和原发性胆汁性肝硬化(PBC)患者45例,采用间接免疫荧光法或免疫印迹法检测血清抗核抗体(ANA)、抗线粒体抗体(AMA)或AMA-M2)、抗平滑肌抗体(ASMA)、抗双链DNA抗体(抗dsDNA)和抗着丝点抗体(ACA);采用ELISA法检测血清免疫球蛋白,包括IgG、IgM和γ-球蛋白。结果 在本组41例AIH患者中,合并HT患者12例,合并GD患者6例,在45例PBC患者中,合并HT患者8例,合并GD患者7例;AIH患者血清IgG水平为17.5(14.8,19.8)g/L,显著低于AIH合并HT组【21.6(17.5,29.0)g/L,P<0.05】或AIH合并GD组【22.4(20.2,26.4)g/L,P<0.05】,血清γ-球蛋白为22.2(19.3,25.6)%,显著低于合并HT组【26.5(22.2,32.2)%,P<0.05】或合并GD组【27.1(24.3,32.0)%,P<0.05】;PBC患者年龄为(55.2±1.1)岁,显著小于合并HT组【(62.4±1.6)岁,P<0.05】或合并GD组【(62.2±1.5)岁,P<0.05】,血清IgG水平为15.4(12.2,18.0)g/L,显著低于合并HT组【20.3(16.8,24.7)g/L,P<0.05】或合并GD组【21.3(16.8,25.6)g/L,P<0.05】,血清γ-球蛋白水平为21.2(17.8,25.6)%,显著低于合并HT组【26.7(21.7,30.4)%,P<0.05】或合并GD组【25.4(22.2,29.4)%,P<0.05】。结论 AILD合并AITD的发病率较高,合并AITD患者血清IgG和γ-球蛋白水平较高,其原因还有待于进一步研究。     

Anticardiolipin antibodies in patients with autoimmune diseases: Isotype distribution and clinical associations

Summary A prospective study of IgG and IgM isotypes of anticardiolipin antibodies (aCL) was performed in a series of 167 patients with various autoimmune diseases, including rheumatic and nonrheumatic disorders, and in a group of 100 healthy blood donors. The IgG aCL serum was regarded as positive if a binding index (BI) greater than 2.85 (3.77 SD) was detected and a BI greater than 4.07 (3.90 SD) was defined as positive for IgM aCL. Forty patients (24%) were found to be positive for IgG and/or IgM aCL. IgG aCL were detected in 23% of patients with systemic lupus erythematosus (SLE), in 9% with idiopathic thrombocytopenic purpura, in 7% with progressive systemic sclerosis, and in 6% with dermatomyositis-polymyositis. IgM aCL were present in 43% patients with primary biliary cirrhosis, in 33% with rheumatoid arthritis, in 22% with SLE, and in 8% with giant-cell arteritis. IgG aCL were found to have a significant association with thrombosis and thrombocytopenia, and IgM and aCL with haemolytic anaemia and neutropenia, in SLE but not in the other autoimmune diseases. The identification of these differences in the aCL isotype associations, depending on the autoimmune disorder, may improve the clinical usefulness of these tests.     

自身免疫性肝病的回顾性研究

目的 提高对自身免疫性肝病的认识,以利于早期诊断、早期治疗.方法 回顾性对81例自身免疫性肝病患者进行诊断,比较自身免疫性肝炎(AIH)、原发性胆汁性肝硬化(PBC)及其重叠综合征(OS)的临床、血液化学及病理特点.结果 81例患者中,女性占91.4%;总体误诊率为45.7%,OS漏诊率为96.7%,初始诊断为肝硬化者60.5%(49/81),其中37%(30/81)为失代偿期肝硬化.AIH组18.2%(6/33)以急性肝功能衰竭发病,明显高于PBC、OS组,3组患者症状、体征基本一致,AIH、OS组患者丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)水平及抗核抗体(ANA)阳性率明显高于PBC组(Z=6.411,P=0.041;Z=7.980,P=0.019;X2=11.951,P=0.003),PBC、OS组患者血清门冬氨酸氨基转移酶(GGT)、碱性磷酸酶(ALP)、总胆固醇、载脂蛋白B水平及抗线粒体抗体(AMA)阳性率明显高于AIH组(Z=37.327,P=0.000;Z=12.929,P=0.002;Z=16.722,P=0.000;Z=6.695,P=0.035;X2=31.219,P=0.000).结论 自身免疫性肝病误诊率高.AIH、OS患者氨基转移酶升高明显,ANA阳性率高,PBC、OS患者GGT、ALP升高明显,血脂代谢障碍,AMA阳性率高.     

Serum isoamylases in patients with autoimmune rheumatic diseases

We studied sera of 107 patients with autoimmune rheumatic diseases (46 with classical rheumatoid arthritis (RA), 36 with systemic lupus erythematosus (SLE) and 25 with primary Sj?gren's syndrome (SS). None of these patients had abdominal pain or gastrointestinal symptoms at the time of blood collection. We used as controls 81 normal age and sex matched volunteers. The presence of hyperamylasemia i) of P-type in 6 of 46 patients (13%) with RA and ii) of P-type and S-type in 11 of 36 patients (30.5%) with SLE and 6 of the 25 patients (24%) with primary SS suggests that asymptomatic pancreatic damage in autoimmune rheumatic diseases may occur frequently especially in patients with SLE. We conclude that the hyperamylasemia in these patients probably reflects a slow, subclinical, inflammatory process of the exocrine glands.     

Immunohistochemically proven cytomegalovirus gastrointestinal diseases in three patients with autoimmune diseases

Cytomegalovirus (CMV) disease is a serious infectious complication in compromised hosts. Therefore, there are several studies on the diagnosis and prophylactic/pre-emptive therapy of CMV diseases in patients with solid organ transplants, bone marrow transplants, hematopoietic stem cell transplants, and HIV diseases. However, in patients with autoimmune disease, there are only few studies on the diagnosis and prediction of CMV diseases. In the present article, we described three autoimmune cases that developed CMV gastrointestinal disease because of therapy-related immunosuppression. Although all three patients had a low-level CMV antigenemia without diarrhea or melena, CMV was detected in the gastrointestinal tract tissue. We concluded that CMV-antigenemia assay has a limited value in the diagnosis and prediction of CMV gastrointestinal disease in patients with autoimmune diseases, and that immunohistochemical confirmation of CMV tissue involvement should be recommended especially when the typical clinical gastrointestinal manifestations are lacking.     

自身免疫病并发卡氏肺孢子菌肺炎的临床分析

目的了解自身免疫病并发卡氏肺孢子菌肺炎（PCP）的临床特点。方法回顾性分析北京协和医院12例自身免疫病并发PCP患者的临床特点和外周血T细胞亚群的改变。结果12例自身免疫病合并PCP患者的临床主要表现为发热12例、咳嗽9例、咳痰9例及明显呼吸困难12例，并呈进行性加重，血气分析均显示Ⅰ型呼吸衰竭；胸部X线片主要表现为双肺间质纹理改变和斑片影。外周血T细胞总数（0．44±0.31）×10^9／L、CD4^＋T淋巴细胞（0．120±0.079）×10^9／L、CD8^＋T淋巴细胞（0．248±0.252）×10^9／L，均明显下降，CD4／CD8比值倒置，与正常人比较差异均有统计学意义（P〈0.05）。经复方磺胺甲嗯唑和糖皮质激素、给氧、辅助通气治疗后，3例好转，9例死亡。结论自身免疫病合并PCP病死率高，当患者出现进行性呼吸困难、Ⅰ型呼吸衰竭及胸部X线片示肺间质浸润，CD4^＋淋巴细胞计数明显下降时，应警惕合并PCP的可能，早期诊断及治疗可改善预后。     

Antibodies to the collagen-like region of C1q in sera of patients with autoimmune rheumatic diseases

Antibodies to the collagen-like region of C1q have recently been observed in sera of patients with systemic lupus erythematosus (SLE). In this study, we documented that these antibodies were present in 47.3% of SLE patient sera, whereas they were uncommon in sera from patients with rheumatoid arthritis (2.8%) and Sj?gren's syndrome (12.8%), as well as in normal sera (6.4%). Markedly elevated antibody levels (greater than 4 SD above the normal mean) were observed almost exclusively in sera of patients with SLE. Levels of antibodies to the collagen-like region correlated highly with levels of solid-phase C1q-binding IgG when analyzed by the C1q solid-phase assay for immune complexes (r = 0.87). We previously found that, after sucrose density gradient ultracentrifugation, a predominance of the solid-phase C1q-binding IgG in SLE sera sediments as monomeric IgG. These findings, together with the present data, indicate that reactivity of SLE patients' sera in the C1q solid-phase assay reflects primarily the presence of antibodies to the collagen-like region, and not the presence of immune complexes.     

自身免疫性疾病合并心房颤动导管消融的疗效

目的探讨自身免疫性疾病（免疫病）对心房颤动（简称房颤）导管消融的影响。方法回顾性分析本院在三维标测系统指导下行射频消融的房颤合并激素和免疫抑制剂治疗稳定后的免疫病患者共15例（免疫病组）,并按照1∶4比例匹配了60例房颤类型、性别、年龄（±2年）、手术时间（±1年）的非免疫病房颤患者（非免疫病组）。比较两组包括C反应蛋白在内的临床特征及房颤导管消融的疗效复发情况。复发定义为消融术后发生持续30 s以上的房性快速性心律失常。结果免疫病组C反应蛋白显著高于非免疫病组（6.14±9.50 mg/dl vs 1.81±2.35 mg/dl,P=0.001 8）,其它临床指标两组无差异。随访462±416天,两组房颤复发率无差异[33.33%（5/15）vs35%（21/60）,P〉0.05]。免疫病组5例均在81天内复发（中位数18 vs 92 d,P=0.037 3）。免疫病组临床症状改善明显（66.7%,10/15）。结论经激素和免疫抑制剂等治疗稳定后,免疫病合并房颤患者行导管消融术是安全、有效的。术后早期房颤复发率高。     

Antibodies to human immunodeficiency virus (HIV-1) in autoimmune diseases: Primary Sjögren's syndrome,systemic lupus erythematosus,rheumatoid arthritis and autoimmune thyroid diseases

Summary The aetiology of autoimmune diseases remains unknown. The relationship between virus, and more recently retrovirus, has been suggested with this group of diseases. Immunoblotting is a useful method for determining the presence of proteins coded by different retrovirus genes. Since the prevalence of these types of proteins in patients with primary Sjögren's syndrome (SS), systemic lupus erythematosus (SLE), rheumatoid arthritis (RA) and autoimmune thyroid diseases has not been fully established, the aim of this work was to determine the prevalence of antibodies to immunodeficiency human virus type 1 (HIV-1) proteins in these diseases and their possible relationship with the presence of anti-nuclear, anti-DNA, anti-SSA (Ro) and anti-SSB (La) autoantibodies. Antibodies to human immunodeficiency virus (HIV-1) were studied in a group of 341 patients with autoimmune diseases (77 SS, 98 SLE, 75 RA, 91 autoimmune thyroid diseases) and 126 blood donors as a control group. A Western blot was used to detect antibodies to HIV-1, and a double polymerase chain reaction (PCR) using nested primers in the gag and pol gene of HIV-1. Antinuclear antibodies, anti-DNA, anti-SSA (Ro) and anti-SSB (La) were determined by enzyme-linked immunosorbent assays.At least one band was shown on immunoblotting in 26% of patients with autoimmune diseases and 35% of controls. The presence of antibodies to p55 or p68 proteins in patients with SS or SLE proved to be the only statistically significant difference between the other autoimmune diseases studied and the control group. These antibodies were not associated with autoantibodies, ANA, DNA, SSA (Ro) or SSB (La). Initially, PCR assay was performed to rule out the presence of HIV-1 virus; results were always negative, as expected. Our results suggest that the presence of p55 and p68 in Western blot for HIV-1 helps differentiate patients with SS or SLE, from those with RA or autoimmune thyroid disease and from a control group.     

Prevalence of anti-endothelial cell antibodies in patients with autoimmune diseases

Summary The prevalence of anti-endothelial cell antibodies (AECA) of IgA, IgG and IgM classes was studied by means of enzyme-linked immunosorbent assays (ELISA) in 466 patients with autoimmune/inflammatory disorders. The reference limits in the ELISAs for the AECA were determined from a random population sample of 249 subjects. The frequency of AECA was highest in patients with SLE (n=42), 14.6% mainly of IgG class, and the presence of AECA correlated with disease activity in these patients. In the RA patient group (n=200), 9.5% had AECA, mostly of IgA type. We found no association between the presence of AECA and extra-articular manifestations of RA or survival rate. In patients with undefined connective tissue disease (n=57), ankylosing spondylitis (n=109), and psoriatic arthritis (n=58), the frequency of AECA corresponded to that of the random population sample. In a cohort of samples sent to the laboratory for determination of anti-nuclear antibodies (ANA) there was a correlation between the presence of ANA and AECA. Our findings indicate that RA patients are characterized by IgA class AECA, whereas SLE patients have IgG class AECA also correlating to disease activity.     

Frequency of rheumatic diseases in patients with autoimmune thyroid disease

We aimed to investigate the frequency of rheumatic diseases in patients suffering from autoimmune thyroid diseases (ATD). Sixty-five patients (56 F, 9 M), who were followed by diagnosis of ATD, were questioned and examined for the presence of rheumatic disease. Basic laboratory tests and antithyroid antibodies, antinuclear antibody and rheumatoid factor (RF) levels were also measured by appropriate methods. Various rheumatic diseases were detected in 40 (62%) of patients with ATD. The most frequent rheumatic conditions were fibromyalgia, recurrent aphthous stomatitis, osteoarthritis, keratoconjunctivitis sicca and xerostomia and carpal tunnel syndrome which were detected in 20 (31%), 13 (20%), 10 (15%), 9 (14%) and 8 (12%) of patients, respectively. Autoimmune diseases, except Sjogren’s syndrome, which were detected in ten patients with ATD, are as follows—vitiligo: two; autoimmune hepatitis: two; oral lichen planus: one, ulcerative colitis: one, inflammatory arthritis in four patients (two of them had rheumatoid arthritis, one had psoriasis and psoriatic arthritis and one had mixed collagen tissue disease). RF was positive in two patients, one of them had rheumatoid arthritis and FANA was positive in six (9%) patients; all of them had hypothyroidism. The frequency of rheumatic diseases seems to be higher in patients suffering from ATD. Initial evaluation and a regular checking for rheumatic diseases in patients suffering from ATD were recommended.     

Soluble HLA in saliva of patients with autoimmune rheumatic diseases

OBJECTIVES: The limited number of studies addressing the presence of soluble human leukocyte antigen (HLA) in body fluids such as tears, urine, sweat, and saliva are restricted to healthy subjects. In this study, we applied solid-phase enzyme-linked immunoassay to quantify soluble HLA class I (sHLA-I) and class II (sHLA-II) molecules in saliva and in selected serum samples obtained from patients with systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and Sj?gren's syndrome (SS). RESULTS: While saliva from normal subjects (n=35) contained levels of sHLA-I that were undetectable (n=7) or ranged from 9 ng/ml to 70 ng/ml (30+/-3.7 ng/ml, n=28), sHLA-I among 38 patients with moderately active RA ( n=24) or SLE (n=14) were significantly elevated (222+/-81.4 ng/ml and 120+/-27.3 ng/ml, respectively, P<0.0001). Intriguingly, sHLA-I levels were even higher in patients whose disease was regarded as active. Specifically, sHLA-I averaged 683+/-189 ng/ml in patients with active RA (n=13) and 230+/-24.5 ng/ml in patients with active SLE (n=7). This was significantly higher than in patients with milder forms of these diseases (P<0.0001). All five subjects with SS had severe disease with high levels of sHLA-I (mean 486+/-86 ng/ml). The concentrations of saliva sHLA-II in the disease groups studied were comparable with levels found in normal controls. The sHLA-I in severe and mild states was investigated in purified serum and saliva from a patient with SS. While 44-kDa fragments of serum HLA-I were detectable in severe SS, they were undetectable in saliva HLA at any time; 35-37-kDa fragments of serum or saliva HLA-I were detected during both mild and severe disease. Interestingly, the 39-kDa fragment was detected in both body fluids during severe but not mild forms of SS. Similarly, the isoforms with the molecular masses 39 kDa and 44 kDa were mainly identified in the purified material obtained from serum of SLE patients. CONCLUSIONS: Collectively, our data suggest that the measurement of soluble HLA in body fluids can be of both diagnostic and prognostic value in the assessment of patients with autoimmune rheumatic disorders. The mechanism by which sHLA enters saliva is unclear, but they probably are not acquired from serum.     

自身免疫性肝病患者血清IgG4水平分析

探讨不同自身免疫性肝病患者血清免疫球蛋白G4（immunoglobulin G4,IgG4）水平差异,并分析不同血清IgG4水平的自身免疫性肝病患者临床特点的差异。方法收集自身免疫性肝病患者65例,其中自身免疫性肝炎（AIH）11例、原发性胆汁性肝硬化（primary biliary cirrhosis,PBC）47例及AIH与PBC重叠综合征7例。采用免疫散射比浊法检测三组患者血清IgG4水平,并分析三组之间血清IgG4水平的差异。根据血清IgG4水平的不同进行分组,分析不同血清IgG4水平的自身免疫性肝病患者临床特点的差异。对组间正态分布的计量资料的比较应用独立样本t检验,对非正态分布者采用Mann-Whitney U检验。计数资料的比较采用Fisher’s确切概率法。结果 AIH患者血清 IgG4水平为642.2 mg/L （97.7 mg/L~1687.0 mg/L）,高于 PBC 患者[153.9 mg/L（78.9 mg/L~400.3 mg/L）,P=0.076]及重叠综合征患者[229.9 mg/L（154.9 mg/L~417.9 mg/L）,P=0.388],无统计学差异。其中3例AIH患者血清IgG4水平异常升高（≥1350 mg/L）,与血清IgG4水平较低的8例AIH患者比,IgG4水平和IgG4/IgG比值较高,差异具有统计学意义（P〈0.05）;3例血清IgG4水平≥1350 mg/L的AIH患者均合并2型糖尿病,其中1例合并类风湿性关节炎,而其他8例AIH患者未合并其他自身免疫性或代谢性疾病;血清IgG4水平较高（IgG4水平≥200 mg/L）的14例PBC患者与IgG4水平较低的33例PBC患者比,血清总胆红素水平较高[（45.09±74.85）μmol/L 对（26.38±23.03）μmol/L,P=0.05]。结论与PBC及PBC与AIH 重叠综合征患者比,AIH患者血清IgG4水平较高。血清IgG4水平较高的AIH患者可能较易合并其他自身免疫性或代谢性疾病。     

Patient-reported outcome measure of the quality of life in Ugandans living with autoimmune rheumatic diseases

Aim of the workTo assess the patient reported outcome measure (PROM) of the quality of life (QoL) of patients with autoimmune rheumatic diseases (RDs) attending two tertiary care rheumatology clinics in Uganda.Patients and methodsPatients with a confirmed diagnosis of RD and receiving disease modifying anti-rheumatic drugs (DMARDs) were studied. Health index and overall self-rated health status were assessed using the EuroQol 5-dimension (ED-5D-5L) questionnaire tool.Results74 patients were studied: 48 (64.9%) had rheumatoid arthritis (RA), 14(18.9%) systemic lupus erythematosus (SLE), and 12(16.2%) had other RDs; spondyloarthritis (n = 5), systemic sclerosis (n = 3), juvenile idiopathic arthritis (n = 2), and idiopathic inflammatory myositis (n = 2). Their mean age was 45 ± 17 years and 69 (93.2%) were female. 14(18.9%) were on concomitant herbal medication and 26(35.1%) self-reported at least 1 adverse drug reaction. Any level of problem was reported by 54(72.5%) participants for mobility, 47(63.5%) for self-care, 56(75.6%) for usual activity, 66(89.1%) for pain and discomfort, and 56(75.6%) for anxiety/depression. The mean health index of the patients was 0.64 ± 0.16 and the overall self-rated health status was 58.1 ± 16.7. Patients with SLE (0.74 ± 0.12) had higher health index compared to those with RA (0.60 ± 0.17) or other RDs (0.70 ± 0.1) (p < 0.007). Overall self-rated health status was comparable across clinical diagnoses (p = 0.23). Both the index and self-reported status were better for patients who received private hospital care compared to public hospital (p < 0.0001 and p = 0.01).ConclusionThere is a substantial negative impact of autoimmune rheumatic diseases on quality of life of patients, especially those receiving care from a public facility in Uganda.     

Sex- and age-specific incidence of autoimmune rheumatic diseases in the Chinese population: A Taiwan population-based study

Objectives

The purpose of this study was to estimate the sex- and age-specific incidence rates of major autoimmune rheumatic diseases (ARDs) in Taiwan using a population longitudinal database.

Methods

A health insurance database containing the records of 1,000,000 beneficiaries of Taiwan National Health Insurance from 2005 to 2009 was used.

Results

Between 2005 and 2009, the overall incidence rate of the major ARDs was 29.8 (95% CI = 28.3–31.3) per 100,000 person-years. Among the ARDs studied, the incidence of rheumatoid arthritis (RA; per 100,000 person-years) was highest (17.2, 95% CI = 16.1–18.4) and was followed by Sjögren's syndrome (11.8, 95% CI = 10.8–12.7), systemic lupus erythematosus (SLE; 7.2, 95% CI = 6.5–8.0), systemic sclerosis (SS; 1.1, 95% CI = 0.8–1.4), vasculitis (1.0, 95% CI = 0.7–1.3), Behçet disease (0.9, 95% CI = 0.6–1.1), dermatomyositis (DM; 0.7, 95% CI = 0.5–1.0), and polymyositis (PM; 0.6, 95% CI = 0.4–0.8). Females had a higher incidence ratio than did males, but a significant female/male incidence ratio was only observed for SLE (8.5, 95% CI = 6.1–12.0), Sjögren's syndrome (6.0, 95% CI = 4.8–7.6), RA (3.0, 95% CI = 2.6–3.5), and SS (2.6, 95% CI = 1.4–4.6).

Conclusions

ARDs are three to four times more common among women than among men in the Chinese population of Taiwan. The incidence of RA was the highest, followed by Sjögren's syndrome and SLE, while the incidence of Behçet disease was the lowest in this study. This nationwide, population-based, longitudinal epidemiological study of ARDs in Taiwan provides data for future global comparisons and may provide clues as to the etiology of these diseases.