Prior mycobacterial infection linked to
By Sara Freeman
Previous infection with nontuberculous mycobacteria was associated with an 11 times increased risk
of later developing Sjögren’s syndrome in a large population-based
study reported at the congress.
Study investigator Dr. Hsin-Hua
Chen and his colleagues at the Tae -
ichung (Taiwan) Veterans Hospital
found that the adjusted odds ratio
for having Sjögren’s syndrome after nontuberculous mycobacteria
infection (NTM) was 11. 24, with a
95% confidence interval of 2.37-
The risk for having Sjögren’s
syndrome was found to be highest
in those aged 40-65 years versus
those older than 65 (aOR, 39. 24;
P = .09) and in those with no prior history of bronchiectasis (aOR,
37.98; P = .09). Although, in both
analyses, the 95% CIs were very
wide ( 3.97-387.75 and 3.83-376.92,
respectively), and the P values
were not significant.
“These data might support the
need for screening for Sjögren’s
syndrome in patients with NTM
Dr. Chen and his colleagues de-
cided to look at the association
between tuberculous or nontuber-
culous mycobacteria with Sjögren’s
syndrome for several reasons.
First, mycobacterial infections have
been linked to the development of
autoimmunity. Second, there has
been an increased incidence of
tuberculosis reported in patients
with Sjögren’s syndrome. Third,
both Sjögren’s and infection with
NTM occurred predominantly in
middle-aged women, suggesting a
shared potential mechanism.
To investigate a possible asso-
ciation, a matched case-control
study was conducted with data
obtained from the Taiwan National
Health Insurance Database. There
were 5,751 new cases of Sjögren’s
syndrome that were identified and
validated by at least two qualified
rheumatologists and matched to
86,265 controls from the general
population according to age, gen-
der, and year of diagnosis. Patients
with rheumatoid arthritis and sys-
temic lupus erythematosus were
excluded. International Classifica-
tion of Disease codes were used to
identify individuals who had prior
TB or NTM infections.
The mean age of patients in both
groups was 55 years, and approxi-
mately 87% of participants in both
groups were female. There was a
significant difference in baseline
Charlson Comorbidity Index scores
between cases and controls (0.5 vs.
0.4; P less than .001), and more cas-
es than controls had bronchiectasis
( 4.1% vs. 1.3%; P less than .001). Re-
sults were adjusted accordingly.
While there was an association between NTM infection and
Sjögren’s syndrome, there was no
association with tuberculous mycobacteria infection.
Of course, it is not clear if infection with NTM actually causes the
condition, and reverse causality
cannot be ruled out, Dr. Chen said,
so further mechanistic studies
would be needed to investigate
NTM’s possible role in the development of Sjögren’s syndrome.
Dr. Chen and coauthors had
nothing to disclose.
“These data might support the need for screening for
Sjögren’s syndrome in patients with NTM infection,
particularly among those aged 40-65 years and those
without a history of bronchiectasis.“
Histopathologic image of focal lymphoplasmacytic infiltration in the minor
salivary gland associated with Sjögren syndrome.