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Autoimmune Diseases Run in Lupus Patient Families


Relatives of patients with systemic lupus erythematosus (SLE) have a higher risk of developing SLE and other autoimmune diseases compared with the general population, a population study found.

Based on data from the 23-million member national health system in Taiwan, the study found first-degree relatives of individuals with SLE were 16 times more likely to develop SLE (relative risk 16.31, 95% CI 14.60-18.23), as well as other autoimmune diseases, especially for primary Sjögren syndrome (RR 5.87, 95% CI 4.89-7.05), and systemic sclerosis (RR 5.40, 95% CI 3.37-8.65), compared with the rest of the country, Chang-Fu Kuo, MD, PhD, of the University of Nottingham, and colleagues reported in JAMA Internal Medicine.

According to the authors, previous research estimates that 0.07% of the population of Taiwan, and 0.10% of the population of the U.K., has SLE.
Kuo's team of researchers looked at the entire Taiwan National Health Insurance (NHI) Research Database, which by 2010 covered 99.5% of the nation's population, and identified 23,658,577 men and women in the 2010 database.

Out of the group, 21,009,551 were classified as parent-child relationships, 17,168,340 were full-blooded sibling pairs, and 342,066 were twin pairs, and all of these individuals were clustered into 4,229,301 families.

In the analysis, individuals were counted more than once if they fulfilled multiple roles within a family, such as being both someone's child and someone's parent.
The researchers looked for diagnoses of SLE from 1995 to 2010, as well as other autoimmune diseases like rheumatoid arthritis, systemic sclerosis, primary Sjögren syndrome, idiopathic inflammatory myositis, type 1 diabetes, multiple sclerosis, myasthenia gravis, inflammatory bowel disease, and vasculitis.

Adjustments were made for age, gender, occupation, income level quintiles, family size, and level of urbanization.

The risk for relatives of SLE patients also developing SLE was highest, not surprisingly, among twin siblings (RR 315.94, 95% CI 210.66-473.82). The next highest familial risk factor was found among regular siblings (RR 23.68, 95% CI 20.13-27.84), parents (RR 11.44, 95% CI 9.74-13.43), and offspring (RR 14.42, 95% 12.45-16.70).

Spouses without genetic similarity were also at increased risk of developing SLE (RR 4.44, 95% CI 2.38-8.30).

Stratified by influence, Kuo's team attributed phenotypic variance of SLE 43.9% for heritability, 25.8% for shared environmental factors, and 30.3% for non-shared environmental factors.

For first-degree relatives of individuals who had SLE, there was also a risk of developing other autoimmune disorders. These included:

  • Primary Sjögren syndrome (RR 5.87, 95% CI 4.89-7.05)
  • Systemic sclerosis (RR 5.40, 95% CI 3.37-8.65)
  • Myasthenia gravis (RR 2.95, 95% CI 2.04-4.26)
  • Idiopathic inflammatory myositis (RR 2.77, 95% CI 1.45-5.32)
  • Rheumatoid arthritis (RR 2.66, 95% CI 2.28-3.11)
  • Multiple sclerosis (RR 2.58, 95% CI 1.16-5.72)
  • Type 1 diabetes (RR 1.68, 95% CI 1.22-2.32)
  • Inflammatory bowel disease (RR 1.39, 95% CI 0.66-2.91)
  • Vasculitis (RR 0.86, 95% CI 0.43-1.71)

The authors noted that previous estimates had put heritability of SLE at 66%; but also, in Taiwan criteria for an SLE diagnosis is very strict and must be labelled by rheumatologists alone, which may have lowered rates of reporting.
"Genetic predisposition plays a crucial role in susceptibility, and environmental exposure can cause epigenetic change or trigger activation of innate and adaptive immune response to induce or accelerate the development of SLE in susceptible individuals," the authors wrote.

The study had several limitations, including a lack of ability to differentiate between monozygotic and dizygotic twins, and lack of more detailed clinical information on the SLE patients.

Story Source: The above story is based on materials provided by MEDPAGETODAY
Note: Materials may be edited for content and length

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