Association of Primary Sjögren’s Syndrome and Vitamin B12 Deficiency: A Cross-Sectional Case-Control Study

Abstract

Descriptive and retrospective studies without control groups have suggested a possible association between primary Sjögren’s syndrome (pSS) and vitamin B12 (B12) deficiency. This is of importance because several mucosal and neurological features are common to these two conditions and could be prevented or reversed in case of B12 deficiency. We aimed to evaluate the association between pSS and B12 deficiency. We prospectively assessed the B12 status of 490 patients hospitalized in an internal medicine department over a 15-week period. Patients with pernicious anemia were excluded. We extracted patients with pSS and paired them with controls according to age and sex, with a 1:5 ratio. Twenty-one pSS patients were paired with 105 control patients. The median age was 70 years old (51–75) and 95.2% of patients were women. The plasma B12 level was lower in pSS patients (329 (293–521) ng/L vs. 456 (341–587) ng/L, p < 0.0001). B12 deficiency was associated with pSS (42.9% among pSS patients vs. 11.4% among controls), even after adjustment for other causes of B12 deficiency (OR 6.45 (95%CI: 2.08–20.0)). In conclusion, pSS appeared to be associated with B12 deficiency, even after the exclusion of pernicious anemia. This justifies screening and treating B12 deficiency in pSS patients.

Coexistence of Primary Sjögren’s Syndrome and Autoimmune Gastritis With Pernicious Anemia and Subacute Combined Degeneration of the Spinal Cord: Case Report and Literature Review

“…The etiology of spinal cord SCD is neurological lesions mainly caused by vitamin B12 deficiency. Some studies have confirmed that pSS can also lead to reduction of vitamin B12 ( 22 , 24 , 25 ), but the coexistence of the two diseases has not been reported until now. We supposed that spinal cord SCD in our patient was due to the reduction of vitamin B12 which may have been associated with pSS or AIG.…”

“…The condition of our patient helps us to understand the association of AIG and pSS. Additionally, according to previous studies, pSS and vitamin B12 deficiency have similar mechanisms in causing neuropathy, and some researchers have speculated that patients with pSS associated with vitamin B12 deficiency are more prone to neuropathy ( 22 ).…”

Decreased Protein Levels and Vitamin B12 Plasma Concentration in Primary Sjögren Syndrome are Associated with Peripheral Neuropathy: A Case-Control Study

“…Nutritional deficiencies have previously been associated with pSS, predominantly vitamin B12 , vitamin A and iron deficits [4,19,20]. Our research focused on the possible benefits of identifying early patterns of vitamin B12 and protein blood concentrations in order to predict later onset of peripheral neuropathy.…”

“…An illustrative example is vitamin B12 deficiency, which is highly associated with pSS. A recent study demonstrated low vitamin B12 serum levels in 42.9% pSS patients, with no history of significant comorbidities, compared to 11.4% in the control group [4]. Given that nearly 80% of vitamin B12 deficiency patients display PNS impairment, it is crucial to identify this subset of pSS patients [5].…”

Autoimmune polyendocrine syndromes associated with autoimmune rheumatic diseases

“…Interestingly, Urbanski et al [54] examining vitamin B 12 deficiency found low levels of the vitamin in 43% of patients with SS and 11% in the control group. Moreover, the research work of Andrés et al [ 55] showed vitamin B 12 deficiency in 8.8% of patients with SS; however, Reumatologia 2023; 61/4 there was no control group in that study, which does not allow one to draw a conclusion about the relationship between these two disorders.…”