Pemphigus encompasses  a group of rare, potentially lethal, mucocutaneous autoimmune bullous dermatoses.  It is well studied that autoimmune disease, such as pemphigus, is likely to  coexist within individuals and their relatives. Several studies have  substantiated the concept of autoimmune diathesis in pemphigus with an array of  autoimmune diseases. 
    While a high burden  of the autoimmune disease had been observed among patients with RA, with 24% of  patients having at least one concomitant autoimmune disease.
    Descriptive cluster  analysis has demonstrated that pemphigus forms a distinct cluster with (RA  autoimmune thyroid diseases (AITD), and type I diabetes mellitus. In the  meanwhile, two other observational studies did not reveal a significant  association between pemphigus and RA. Taken together, the association  between these conditions is inconclusive and yet to be firmly established both  epidemiologically and genetically.
    Therefore, Khalaf Kridin and colleagues from the Lübeck  Institute of Experimental Dermatology, University of Lübeck, Germany conducted  the present study to evaluate the risk of developing RA during the course of  pemphigus. 
    The authors carried out a large-scale  population-based longitudinal cohort study among 1985 patients with  pemphigus relative to 9874 age-, sex-, and ethnicity-matched control subjects.
    The following observations were noted-
    a.     The incidence of RA was 1.07 and 0.36 per 1000 person-years  among patients with pemphigus and controls, respectively. 
    b.     The lifetime prevalence of RA was 2.3% among cases and 1.8%  among controls. 
    c.      Patients with pemphigus were more than twice as likely to  develop RA as compared to control subjects. 
    d.     The increased risk was robust to a sensitivity analysis  that included only cases managed by pemphigus-related systemic medications.
    Therefore, "pemphigus is  associated with an increased risk of RA. Physicians treating patients with  pemphigus should be aware of this possible association. Further research is  required to better understand the mechanism underlying this association", the  authors concluded. 
    For further reference, log in to:
    Kridin, K., Jones, V.A., Patel, P.M. et al. Patients with pemphigus are at an increased risk of  developing rheumatoid arthritis: a large-scale cohort study. Immunol Res 68, 373–378 (2020). https://doi.org/10.1007/s12026-020-09160-6.
 
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