Wednesday, 24 Apr 2019

You are here

Autoimmune Disease Clustering at ENDO 2019

A twin registry database study was presented at the Endocrine Society's annual meeting (ENDO 2019) in New Orleans, showed that that having autoimmune disease significantly increases the risk of other autoimmune disorders and that autoimmune clustering was highest in Addison's disease and vitiligo. 

Skov and his co-workers also looked at the likelihood of both twins in a pair having different autoimmune diseases -- which they named "pseudoconcordance" -- and compared these rates to measure autoimmune clustering.

Investigators from the Karolinska Institute set out to study heritability and overlap between seven autoimmune diseases known to cluster. Using twin studies they identified autoimmune diseases that tend to cluster, knowing that concordance rates would be higher in monozygotic than in dizygotic twins.

Their study of 116,320 twins from the Swedish Twin Registry found that Addison's disease, Celiac disease, and type 1 diabetes, are strongly influenced by genes with heritability greater than 85 percent. For example, the probandwise concordance rates ranged from 0.71 in monozygotic twins (MZ) with Addison’s disease to 0 in dizygotic twins (DZ) with Addison’s disease and vitiligo.  

They believe that environmental factors contribute to a lesser risk in Hashimoto's hypothyroidism, vitiligo, Graves' disease and atrophic gastritis

In the context of the seven autoimmune disorders studied, the authors fels that the probandwise concordance rates for individual diseases underestimate the burden of autoimmunity and that the genetic influence on disease occurrence for individual disorders is high.

The author has no conflicts of interest to disclose related to this subject

Add new comment

More Like This

Improved Survival in Lupus

A longitudinal study of systemic lupus erythematosus (SLE) from the Toronto Lupus Clinic has shown that mortality has decreased over time.

The cohort incuded 1732 SLE patients followed between 1971 and 2013. The cause of death was gleaned from death certificates, autopsy reports, hospital records or the records of the family physicians.  

EULAR 2019 Update to Lupus Management

The goal of SLE treatment is remission or low disease activity and flare prevention. Hydroxychloroquine is recommended in all patients with lupus, at a dose not exceeding 5 mg/kg real body weight. Glucocorticoids (GC) should be minimised to less than 7.5 mg/day (prednisone equivalent). Appropriate initiation of immunomodulatory agents (methotrexate, azathioprine, mycophenolate) can be tailored to the clinical scenarios and may allow for tapering or discontinuation of GC.

Mortality Risk Factors in Systemic Sclerosis

A French cohort study of 625 systemic sclerosis (SStc) patients has found a significantly increased mortality risk that can be predicted by common clinical variables.

In addition to a multicenter prospective study, investigators performed a metanalysis on SSc standarized mortality ratios (SMR) and hazard ratios of prognosis factors.

Better Tests Ahead in Lupus

The advent of "big data" and "-omics" technologies offers hope that clinicians will soon have better diagnostics for systemic lupus erythematosus, rheumatologists here were told.

GCA Relapse Risk High with Steroids

Prior to the introduction of tocilizumab to manage giant cell arteritis (GCA), glucocorticoids (GC) have been the mainstay of therapy, but has been limited by relapses in disease. A recent metanalysis shows that relapses occur in nearly half of patients and are related to the duration of therapy rather than the initial dose of GC.

A literature review found 34 studies (2,505 patients) from 8 RCTs of GCA patients only treated with GC.