Risk of Autoimmune Diseases in Patients With Interstitial Cystitis/Bladder Pain Syndrome: A Nationwide Population-Based Study in Taiwan

Abstract

Objective: The association between autoimmune diseases (ADs) and interstitial cystitis/bladder pain syndrome (IC/BPS) has long been investigated. However, the lack of comprehensive descriptions of patients in the literature has made comparison and evaluation impossible. We aim to investigate the risk of systemic ADs in patients with IC/BPS in Taiwan using a population-based administrative database.Methods: This study evaluated 1,095 patients newly diagnosed with IC/BPS between 2000 and 2013, using data from Taiwan's National Health Insurance Research Database. These patients were randomly matched by demographic characteristics with a comparison cohort of individuals without IC/BPS at a ratio of 1:20. Cox proportional hazards regression analysis was used to analyze the risk of ADs, adjusting for age, sex, urbanization, length of hospital stay, and comorbidities adjustment. Sensitivity analysis by propensity score was used to adjust for confounding factors.Results: The adjusted Hazard Ratio (aHR) of ADs for IC/BPS patients was 1.409 (95% CI 1.152–1.725). The subgroup analysis indicated that female or 45–60 years of age had a greater risk of ADs. Furthermore, the subgroup analysis of primary outcomes indicated that IC/BPS had greater incidence with Hashimoto's thyroiditis (aHR = 2.767, 95% CI 1.039–7.368), ankylosing spondylitis (aHR = 2.429, 95% CI 1.264–4.67), rheumatoid arthritis (aHR = 1.516, 95% CI 1.001–2.296), and Sjogren's syndrome (aHR = 1.962, 95% CI 1.37–2.809).Conclusion: IC/BPS was associated with the development of ADs in our study population, especially Hashimoto's thyroiditis, ankylosing spondylitis, rheumatoid arthritis, and Sjogren's syndrome. Clinicians are recommended to be alert to the increased likelihood of developing ADs, particularly for middle-aged women.

Monoclonal Antibody Therapy for the Treatment of Interstitial Cystitis

“…Τhe trigger for the initial formulation of this theory was the epidemiological observation of existing similarities regarding the sex and age distribution of patients with PBS/IC compared to patients with other known autoimmune diseases. 11 , 13 The autoimmunity-based pathophysiological mechanism of PBS/IC was further supported by the clinical concordance found between PBS/IC and various autoimmune syndromes, and also by the fact that PBS/IC is considered as a manifestation of some systemic disorders, such as irritable bowel syndrome, migraine, anxiety, and depression. 14–16 In addition, the autoimmunity-based theory around PBS/IC pathophysiology was fueled by the fact that autoimmune-originating characteristics, including episodic symptom flare and a relapsing and/or treatment-refractory nature, are frequently present in PBS/IC patients.…”

Interstitial Cystitis as a Plausible Cause of Overactive Bladder in Systemic Sclerosis: A Hypothesis

“…However, in a nationwide population-based study evaluating the risk of autoimmune diseases in patients with IC, it was demonstrated that the odds of rheumatoid arthritis were 1.516 times higher and Sjogren's syndrome were 1.962 times higher. Interestingly, the authors found no increased risk of SLE and did not report any SSc-related outcomes due to the limited number of patients [15].…”

Small fiber polyneuropathy: A new therapeutic target in patients with interstitial cystitis/bladder pain syndrome?

“…The autoimmune theory is supported in part by the idea that there is noticeable epidemiological overlap between patients with IC/BPS and other individuals with known autoimmune disease (16,17). Additional support was gained from the finding that in IC/BPS the bladder wall is infiltrated with increased inflammatory cells, such as mast cells, T lymphocytes, and eosinophils (18,19).…”