Patients with chronic periodontitis present increased risk for primary Sjögren syndrome: a nationwide population-based cohort study

Lin, Taichen; Tseng, Chien-Fang; Wang, Yu‐Hsun; Yu, Hui-Chieh; Chang, Yu‐Chao

doi:10.7717/peerj.5109

Cited by 12 publications

(9 citation statements)

References 24 publications

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“…All in all, the results we get may lean toward “correlation.” In addition, we tried to search the studies on the incidence of Sjogren’s syndrome in patients with periodontal disease. Unfortunately, due to the retrieval of only two articles ( 47 , 48 ), meta-analysis could not be conducted, and further relationship could not be obtained. However, both papers concluded that patients with periodontal disease were more likely to have Sjogren’s syndrome.…”

Section: Discussionmentioning

confidence: 99%

The association of periodontal diseases and Sjogren’s syndrome: A systematic review and meta-analysis

et al. 2023

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BackgroundThe relationship between periodontal diseases and Sjogren’s syndrome were found inconsistent in current studies. Our objective is to clarify the relationship between periodontal diseases and Sjogren’s syndrome.MethodsA systematic review was performed and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Electronic databases (EMBASE, PubMed, Web of Science, and Cochrane Library, from inceptions until 24 November 2021) were searched. The Newcastle-Ottawa Scale (NOS) and Agency for Healthcare Research and Quality (AHRQ) were applied to evaluate the quality of studies. Quality assessment of the certainty of evidence was performed based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guidelines. When the output is the ratio, Odds ratio (OR) of periodontal diseases with Sjogren’s syndrome were calculated. When the output is the mean, weighted mean difference (WMD) of periodontal diseases with Sjogren’s syndrome was calculated. We conducted meta-analysis and estimated the pool sensitivity. Begg’s test was used to test the possibility of publication bias. We also carried out meta-regression to clarify the source of heterogeneity (I2 > 50%). Finally, we performed a trial sequential analysis (TSA) to identify the false positive or false negative outcomes that might occur during repeated updates.Results21 studies were included in this systematic review, with a total of 11435 subjects. Meta-analysis of 5 studies showed that there is a positive correlation between periodontitis and Sjogren’s syndrome (OR = 2.12, 95% CI = 1.43–3.17; 5 studies, 6927 participants; low certainty of evidence). Meta-analysis of 16 studies showed that the periodontal condition of patients with Sjogren’s syndrome was worse compared with the control group, and the scores of clinical periodontal parameters were relatively high.ConclusionSjogren’s syndrome patients seem to be more likely to be diagnosed with periodontal diseases. However, our results should be interpreted with caution considering the high heterogeneity.Systematic review registration[https://www.crd.york.ac.uk/prospero/], identifier [CRD42021261322].

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Section: Discussionmentioning

confidence: 99%

The association of periodontal diseases and Sjogren’s syndrome: A systematic review and meta-analysis

et al. 2023

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“…Alternatively, Nikitakis et al (2017) suggested that a dysregulated immune response against the oral microbiome in Sjögren’s patients could be responsible for initiating an autoimmune response in Sjögren’s or involved in its amplification. A Taiwanese case-control study of chronic periodontitis patients, identified from the National Health Insurance Database frequency matched by age, sex, and index year to a cohort from the general population, showed the incidence of Sjögren’s (8.5 y later) was significantly higher in the chronic periodontitis cohort (hazard ratio, 1.79; Lin et al 2018). Szymula et al (2014) in a laboratory study found that the von Willebrand factor type A (vWFA) domain protein produced by Capnocytophaga ochracea was the most potent activator of SSA (Ro).…”

Section: Discussionmentioning

confidence: 99%

Characterizing Microbiota from Sjögren’s Syndrome Patients

Singh

Teles

Uzel

et al. 2020

JDR Clinical & Translational Research

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Objective: To compare the oral microbiota of Sjögren’s syndrome (SS) with that of healthy subjects (HS). Methods: Supragingival and subgingival biofilm samples were collected from the mesial-buccal tooth surfaces of SS patients (n = 57) and age- and sex-matched HS (n = 53). Unstimulated saliva and 8 oral tissue samples were taken using a buccal brush. Caries and periodontal measures were recorded. All supragingival samples and a subgroup of 24 SS and 28 HS subgingival samples, as well as 32 SS and 11 HS saliva and oral tissue samples, were analyzed for their content of 41 bacterial species using checkerboard DNA-DNA hybridization. Mean levels (×105 ± SEM) and percentage of DNA probe counts of each species were determined for each sample site and averaged within subjects in the 2 clinical groups. Kruskal-Wallis tests, adjusting for multiple comparisons and cluster analysis, were used for soft tissue and microbial analysis, and the Mann-Whitney test was used to compare caries and periodontal measures. Results: Mean (×105 ± SEM) total DNA probe counts in supragingival samples were significantly lower (P < 0.001) in the SS (13.3 ± .7) compared to the HS (44.1 ± 6.8) group. In supragingival samples, Veillonella parvula, Fusobacterium nucleatum ss vincenti, and Propionibacterium acnes were markedly elevated in the SS compared to the HS group in both mean (×105 ± SEM) and mean (± SEM) percentage DNA probe counts (P < 0.001). In subgingival samples of SS, V. parvula was significantly different compared to HS (P < 0.05). SS was characterized by high levels of purple and low levels of orange and red complexes. Cluster analysis of oral tissues and saliva demonstrated that the mean microbial profiles for SS patients and the HS group clustered separately. Active root caries (P < 0.003) and attachment loss were significantly higher (P < 0.029) in the SS group compared to the HS group. Conclusion: These findings indicate that saliva is a major controlling factor of intraoral biofilm. V. parvula may be a unique microbial biomarker for Sjögren’s syndrome. Knowledge Transfer Statement The microbiome characterized for Sjögren’s syndrome in salivary hypofunction is shown to be under stress and reduced. Veillonella parvula can be a possible identification of a biomarker for Sjögren’s syndrome.

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“…Recent studies revealed the interaction between EB nuclear antigen 2 (EBNA2) and genetic loci associated with RA, EBNA-1 and Ro-60 antigen in SS [34,35]. Besides, a strict relationship between chronic periodontitis and RA and a verified association between chronic periodontitis exposure and SS risk have also been demonstrated [36,37].…”

Section: Environmentmentioning

confidence: 99%

Overlapping Sjogren’s syndrome reduces the probability of reaching target in rheumatoid arthritis patients: a propensity score matched real-world cohort from 2009 to 2019

Zhang

Gao

et al. 2020

Arthritis Res Ther

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Background: Overlapping Sjogren's syndrome (SS) is not uncommon in rheumatoid arthritis (RA) and considered as a probable detrimental factor of RA. But data on the impact of overlapping SS on RA therapeutic response is limited. Our current study aimed to identify the effect in a real-world cohort from 2009 to 2019. Methods: The medical records of RA patients who visited the rheumatology clinic of our medical center from 2009 to 2019 were reviewed. Their composite disease activity scores at each follow-up point were collected. The therapeutic response between RA patients with SS (RA-SS) and without (RA-noSS) was compared. To correct confounders which may affect the therapeutic response, both propensity score matched and unmatched cohorts were analyzed by using the Cox proportional hazards model. Results: Among the 1099 RA patients, 129 (11.7%) overlapped with SS were validated by positive anti-SSA or a minor salivary gland biopsy with histological changes suggestive of SS. After propensity score matching based on their baseline characteristics, 126 of 129 RA-SS and 126 of 970 RA-noSS patients were statistically extracted. Overlapping SS was associated with a 29%, 26%, 18%, and 22% lower probability of reaching remission defined by DAS28-ESR, DAS28-CRP, SDAI, and CDAI in RA patients, respectively. Similar decreased probability of reaching low disease activity was also observed. Although ESR was most significantly affected (HR 0.69, 95% CI 0.61-0.79), other component of composite RA disease activity score was also affected by overlapping SS. Stratification by age, RF/ ACPA status, or baseline DAS28-CRP was not associated with change of results. Conclusions: Overlapping SS is associated with lower probability of reaching remission or low disease activity in RA patients and should be regarded as one of the poor prognostic factors.

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Patients with chronic periodontitis present increased risk for primary Sjögren syndrome: a nationwide population-based cohort study

Cited by 12 publications

References 24 publications

The association of periodontal diseases and Sjogren’s syndrome: A systematic review and meta-analysis

The association of periodontal diseases and Sjogren’s syndrome: A systematic review and meta-analysis

Characterizing Microbiota from Sjögren’s Syndrome Patients

Overlapping Sjogren’s syndrome reduces the probability of reaching target in rheumatoid arthritis patients: a propensity score matched real-world cohort from 2009 to 2019

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