Infection with Nontuberculous Mycobacteria May Increase Risk for Sjogren’s Syndrome

A history of infection with nontuberculous mycobacteria — linked to chronic pulmonary infections, but unable to cause tuberculosis — may increase the risk for primary Sjögren’s syndrome, according to a large nationwide Taiwanese study.

“Although the exact disease mechanism behind [Sjögren’s syndrome] remains elusive, a variety of environmental, genetic and hormonal factors have been linked with the development and different manifestations of this debilitating disease,” study lead author Hsin-Hua Chen, MD, PhD, from the Taichung Veterans General Hospital, Taiwan, Province of China, said in a press release.

“Identifying [nontuberculous mycobacteria] as one of the triggers will hopefully provide a clue to the future development of a targeted therapy for these patients,” Chen said.

The study, “Association between a history of mycobacterial infection and the risk of newly diagnosed Sjögren’s syndrome: A nationwide, population-based case-control study,” was published in the journal Plos One and presented last summer at the Annual European Congress of Rheumatology (EULAR) 2017, Madrid, Spain.

Researchers used Taiwan’s National Health Insurance Research Data (NHIRD) and identified 5,751 newly diagnosed (primary) cases of Sjögren’s syndrome during a period of five years (2007 to 2012). These were compared to 86,265 non-diseased controls matched for age, sex, and the year of first diagnosis. They made sure that patients with Sjögren’s syndrome had no rheumatoid arthritis or systemic lupus erythematosus.

Patients with a history of nontuberculous mycobacteria infection had 11 times more chance of developing Sjögren’s syndrome, the researchers found. The link was evident particularly among patients 40 to 65 years old or without bronchiectasis, who had 39 times higher risk for the disease.

“Our results suggest the need for surveillance for [Sjögren’s syndrome] in [nontuberculous mycobacteria] infected patients, especially those who are 40-65 years of age and who did not have bronchiectasis, so as to diagnose and treat [Sjögren’s syndrome] early,” researchers wrote.

While patients with Sjögren’s syndrome may present a higher risk for tuberculosis, infection with Mycobacterium tuberculosis, the tuberculosis-causing agent, showed no link with the disease.

“The significant association between [nontuberculous mycobacteria] infection and newly diagnosed [Sjögren’s syndrome] demonstrated in our study certainly supports the need to screen for the presence of [Sjögren’s syndrome] in any patient previously infected with [nontuberculous mycobacteria] to enable prompt diagnosis and treatment,” Chen concluded.