Infections Are Not Increased in Scleroderma Compared to Non-Inflammatory Musculoskeletal Disorders Prior to Disease Onset

Abstract

Abstract:The etiology of scleroderma (SSc) is unknown; immunogenic stimuli such as infections and vaccinations could theoretically be risk factors for scleroderma. Our objective was to assess the relationship between viral and bacterial infections, and vaccinations, prior to diagnosis of SSc compared to non-inflammatory controls. Methods: A questionnaire was sent to individuals with SSc (n =83) and controls (n=351) with non-inflammatory musculoskeletal (MSK) disorders (osteoarthritis, n = 204; tendonitis, n = 58; fibromyalgia, n= 89) from a rheumatology practice. Questions ascertained past infections, exposure to infectious agents and vaccination history. Results: The response rate was 78% (SSc) and 56% (MSK controls). The mean age was 56 ± 1.6 (SSc) and 58 ± 0.9 (MSK); 88% (SSc) and 82% (MSK) were female. No association between prior infections and SSc was observed. In fact, controls were more likely than SSc subjects to report any infection within 1-year prior to disease diagnosis (35% vs. 16%, p<0.006), or to have suffered a trauma to affected joints prior to diagnosis (44% vs. 19%, p<0.0002). Within the 1-year prior to disease diagnosis, controls reported slightly more streptococcal infections (p<0.2), infections with diarrhea and vomiting (p<0.3), and antibiotic use (p<0.09), although none of these results were statistically significant. Histories of any hepatitis, rubella, any bacterial infection, and having had a previous positive tuberculosis skin test were not significantly different between groups and were actually more often reported by the control subjects. SSc reported slightly more hepatitis B (p<0.08), more rheumatic fever (p<0.8) in past, and herpes zoster (p<0.4), although no differences reached significance. Conclusion: This study does not support that self-report of symptomatic infections are more likely to occur ever (prior to diagnosis) or within 1-year prior to symptom onset of SSc, or that vaccinations in adulthood trigger SSc.

Systemic Sclerosis in Males—Deciphering the Enigma of Erasmus Syndrome

“…Further fibrosis predisposes these lungs to bacterial infections like tuberculosis. There is controversial evidence of increased risk of pulmonary tuberculosis in idiopathic systemic sclerosis;[ 18 19 ] however, silica-exposed workers, with or without silicosis, are at increased risk for tuberculosis (2.8–39 times higher than healthy controls). [ 20 ] The increased risk is explained by a modified immune response in silica-exposed lungs, high levels of surfactant protein A in the BAL fluid, and encapsulation of bacilli within the silicotic nodules.…”

Inflammation, Autoimmunity, and Infection in Fibromyalgia: A Narrative Review

“…Since bacterial and viral infections have been implicated in the induction of FM [ 37 ], mast cells could mediate the induction of FM through an inflammatory response following a triggering event of an infectious nature. It was also reported that the number of mast cells in skin biopsies from patients with FM was found to increase approximately threefold compared with healthy subjects [ 38 , 39 ].…”

Impact of mast cells in fibromyalgia and low‐grade chronic inflammation: Can IL‐37 play a role?

“…Several articles have reported that the initiation of FM syndrome is attributed to viral or bacterial infections, since during this process cytokines are generated, activating the HPA axis and provoking pain, depression, and fatigue, which are all symptoms of FM (Pope, Goodwin, Ouimet, Krizova, & Laskin, ).…”