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. 2022 Jun 13:9:903608.
doi: 10.3389/fmed.2022.903608. eCollection 2022.

Risk of Autoimmune Diseases Following Optic Neuritis: A Nationwide Population-Based Cohort Study

Kevin Sheng-Kai Ma  1   2   3   4 , Chee-Ming Lee  5   6   7 , Po-Hung Chen  6 , Yan Yang  8 , Yi Wei Dong  1 , Yu-Hsun Wang  9 , James Cheng-Chung Wei  6   10   11 , Wen Jie Zheng  1
Affiliations

Risk of Autoimmune Diseases Following Optic Neuritis: A Nationwide Population-Based Cohort Study

Kevin Sheng-Kai Ma et al. Front Med (Lausanne). .

Abstract

Objectives: Optic neuritis is (ON) is believed to be an immune-mediated disease; however, the association between optic neuritis and autoimmune diseases remains unclear. This study aimed to identify the incidence rate and adjusted hazard ratio (aHR) of autoimmune diseases in patients with optic neuritis.

Methods: This nationwide, population-based, retrospective cohort study collected patients' data between 1999 and 2013 from the National Health Insurance Research Database in Taiwan. A total of 9,235 patients were included. Using 1:4 propensity scoring, 1,847 patients were enrolled in the optic neuritis group and 7,388 in the non-optic neuritis group according to age, sex, comorbidities, and corticosteroid use. Follow-up was started from the index date and the endpoint was a diagnosis of new-onset autoimmune diseases including, myasthenia gravis (MG), psoriatic arthritis (PsA), systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and ankylosing spondylitis (AS).

Results: The Kaplan-Meier curves depicted that patients with optic neuritis had a higher cumulative incidence of autoimmune diseases than patients without optic neuritis. Cox proportional hazard regression showed that patients with optic neuritis were at a high risk of autoimmune diseases (aHR: 1.40; 95% C.I., 1.05-1.87), including MG (aHR: 4.16, 95% C.I.: 1.33-12.94), SLE (aHR: 3.33, 95% C.I.: 1.24-8.97), and AS (aHR: 2.86, 95% C.I.: 1.54-5.31). Subgroup analysis provided that patients with optic neuritis aged below 65 years (aHR: 1.42, 95% C.I.: 1.03-1.96) or who were females (aHR: 1.59, 95% C.I.: 1.11-2.27) had a significantly increased risk of autoimmune diseases compared to respective controls. The use of corticosteroids reduced the risk of autoimmune diseases in patients with optic neuritis (aHR for corticosteroids non-users: 1.46, 95% C.I.: 1.03-2.07).

Conclusion: Patients with optic neuritis presented with a high risk of autoimmune diseases such as MG, SLE, and AS, especially patients with optic neuritis who were young or females. Corticosteroids attenuated the link between optic neuritis and subsequent autoimmune diseases.

Keywords: ankylosing spondylitis; autoimmune diseases; cohort study; myasthenia gravis; optic neuritis; psoriatic arthritis; rheumatoid arthritis; systemic lupus erythematosus.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Flowchart of the study design.
FIGURE 2
FIGURE 2
Kaplan-Meier curve for the cumulative incidence of autoimmune diseases in the optic neuritis group and non-optic neuritis group.
See this image and copyright information in PMC

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