Lower risk of primary Sjogren’s syndrome in patients with dengue virus infection: a nationwide cohort study in Taiwan

Abstract

The data concerning the association between dengue viruses (DV) infection and autoimmune diseases (ADs) remain unclear and are scarce. This nationwide population-based cohort study assessed the risk of ADs among patients with DV infection. We analyzed Taiwanese medical data from the Registry of the National Notifiable Disease Reporting System of Taiwan's Centers for Disease Control between 1998 and 2015 and identified patients with DV infection. From the entire general population data in the National Health Insurance Research Database, we randomly selected a comparison cohort that was individual matching by age, sex, residence, and index date. We analyzed the risk of ADs using a Cox proportional hazards regression model stratified by sex, age, and residence. We enrolled 29,365 patients with DV infection (50.68% men; mean age, 44.13 years) and 117,460 age-, sex-, and residence-matched controls in the present study. The incidence rates of organ-specific ADs were nonsignificantly higher in the DV cohort than in the non-DV control cohort. An approximately 70% lower risk of primary Sjogren syndrome (pSS) was evident in the DV cohort than in the non-DV control cohort with an adjusted hazard ratio of 0.30 (95% confidence interval 0.13-0.67) after adjusting for comorbidities in matched design. By contrast, the other systemic ADs were nonsignificantly lower in the DV cohort than in the non-DV control cohort. This nationwide long-term cohort study demonstrated that patients with DV infection had a lower risk of primary Sjogren syndrome than those without DV infection. Key Points • This retrospective, longitudinal cohort observational study shows that patients with DV infection had a lower risk of pSS than those without DV infection. • The DV cohort had an approximately 70% lower risk of pSS than the control group, with a multivariate-adjusted HR of 0.30. • On the basis of this result, we contended that DV infection has a protective effect that reduces the risk of pSS.

Integrated Bioinformatics and Validation Reveal Potential Biomarkers Associated With Progression of Primary Sjögren’s Syndrome

“…The upregulated common DEGs were enriched in KEGG terms associated with immune-related pathways and infection-related pathways, including the T cell receptor and B cell receptor signaling pathways. GO terms implicated in pSS pathogenesis include immune system process (38), T cell activation (39-41), B cell activation (42,43), and response to virus (44,45). Previously reported pSS-related genes, including HLA-DRA (8,46), CCL19 (47,48), CXCL9 (49), and CD3D (50), were enriched in our study, suggesting that the related common DEGs are potential biomarkers for pSS.…”

Association Between a History of Dengue Fever and the Risk of Systemic Autoimmune Rheumatic Diseases: A Nationwide, Population-Based Case-Control Study

“…Inconsistent with the findings of our study, a recent cohort study conducted by Chang CC et al reported a decreased risk of primary SS development after dengue infection ( 11 ). The authors excluded patients who were diagnosed with autoimmune diseases within1 year before the diagnosis of dengue infection to confirm the diagnosis of primary SS ( 11 ).…”

“…The authors found that the risk of SLE for patients in the dengue group was significantly higher than that of patients in the non-dengue control group ( 3 ). Few studies have investigated the influence of dengue on the development of autoimmune diseases ( 10 , 11 ). However, to the best of our knowledge, no population-based, case-control study assessed the association between dengue infection and the risk of SARDs.…”

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“…Inconsistent with the findings of our study, a recent cohort study conducted by Chang CC et al reported a decreased risk of primary SS development after dengue infection (11). The authors excluded patients who were diagnosed with autoimmune diseases within1 year before the diagnosis of dengue infection to confirm the diagnosis of primary SS (11). However, given that some primary SS patients may present with other autoimmune diseases, such as Hashimoto's thyroiditis and immune thrombocytopenia purpura, before the diagnosis of SS, the exclusion of patients with other autoimmune diseases before the onset of dengue may lead to an underestimation of the incidence of primary SS in patients with dengue.…”

“…The authors found that the risk of SLE for patients in the dengue group was significantly higher than that of patients in the nondengue control group (3). Few studies have investigated the influence of dengue on the development of autoimmune diseases (10,11). However, to the best of our knowledge, no population-based, case-control study assessed the association between dengue infection and the risk of SARDs.…”