Tuesday, 16 Jul 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.

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

Add new comment

More Like This

Pregnancy Outcomes Improve in Lupus

Pregnancy for patients with lupus has long been considered high risk and associated with both medical and obstetric complications, but outcomes have improved over the last 2 decades and continue to improve. The large decline in in-hospital maternal mortality was greater for lupus pregnancies than for non-lupus pregnancies. Findings from a retrospective cohort study are published in Annals of Internal Medicine.

Blinded by the Use of Antimalarials in Lupus?

Editor's note: July 1 - 5, RheumNow is running the best of EULAR 2019 meeting. Hydroxychloroquine (HCQ) will decrease SLE flares improve lipids, decrease clots, improve survival, augment the response to mycophenolate and are the cornerstone of treatment as per the SLE EULAR guidelines presented at EULAR 2019 in Madrid and also published in ARD. But, if you prescribe them long term, will your patients go blind?

Disparities in Lupus Survival

MMWR has published the outcomes from the Georgia Lupus Registry between 2002 and 2016, finding that black women were not only more likely to die from lupus than white lupus patients; but they died on average 13 years earlier (mean age 51.8 and 52.3 years, respectively) than whites (mean age 64.4 and 65.0 years, respectively). Black women with lupus were 3.34 times more likely to die than black women in the general population, while white women with lupus were 2.43 times more likely to die than white women in the general population. None of the white women with lupus died within 5 years of diagnosis, while mortality was elevated for black women from the date of diagnosis on.

DMARD Success in Myositis-Related Interstitial Lung Disease

It is estimated that up to 50% of patients with idiopathic inflammatory myopathy will be complicated by interstitial lung disease, and having ILD may impart a poor prognosis. A recent review of the Johns Hopkins myositis-related ILD cohort has shown that azathioprine and mycophenolate mofetil use is associated improved lung function and less prednisone use.

Sjögren's Syndrome Differs in Minorities

Minority groups in the U.S. have differing rates of Sjögren's syndrome and exhibit distinct clinical patterns of the disease, a large cross-sectional study revealed. The percentage of American Indians in a SS cohort of 610 patients was much higher than expected, at 25.3%, whereas the percentage of African Americans was lower, at 3.1%. In addition, American Indians had higher levels of disease activity and more extraglandular manifestations, whereas African Americans had a symptom pattern associated with subsequent lymphoma development, researchers reported in Arthritis Care & Research.