Overactive bladder and bladder pain syndrome/interstitial cystitis in primary Sjögren’s syndrome patients: A nationwide population-based study

Autoři: Chun-Kang Lee aff001;  Ching-Pei Tsai aff002;  Tsai-Ling Liao aff003;  Wen-Nan Huang aff005;  Yi-Hsing Chen aff001;  Ching-Heng Lin aff003;  Yi-Ming Chen aff003
Působiště autorů: Department of Medical Education, Taichung Veterans General Hospital, Taichung, Taiwan aff001;  Department of Obstetrics, Gynecology & Women's Health, Taichung Veterans General Hospital, Taichung, Taiwan aff002;  Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan aff003;  Institute of Biomedical Science and Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan aff004;  Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan aff005;  Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan aff006;  Department of Public Health, Fu-Jen Catholic University, New Taipei City, Taiwan aff007;  Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan aff008;  Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan aff009
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0225455


To investigate the risks of overactive bladder (OAB) and bladder pain syndrome/interstitial cystitis (BPS/IC) in primary Sjögren’s syndrome (pSS) patients. A nationwide, population-based cohort study was conducted using data from Taiwan’s National Health Insurance Research Database. From 2001 to 2010, participants with newly diagnosed pSS were recognized as the study group. In addition, a comparison cohort of non-pSS participants was matched for age, gender, and initial diagnosis date. Risks of developing OAB and BPS/IC in pSS patients of different age, sex, and various therapeutic strategies were calculated. Hazard ratios (HR) and a 95% confidence interval (CI) were analyzed by Cox proportional hazard model. In total, 11,526 pSS patients were recognized. The HRs of OAB and BPS/IC in pSS patients were 1.68 (95% C.I.: 1.48–1.91, p<0.01) and 2.34 (95% C.I.: 1.59–3.44, p<0.01), respectively. The risks of OAB and BPS/IC were significantly increased for pSS patients aged < 65 years (HR: 1.73 and 2.67), female patients (HR: 1.74 and 2.34), and patients requiring treatment for dry eyes and dry mouth (HR: 2.06 and 2.93). pSS patients exhibited an increased risk of OAB and BPS/IC. Female gender, younger age, and severe glandular dysfunction requiring treatments were potential risk factors.

Klíčová slova:

Bladder – Coronary heart disease – Eyes – Outpatients – Bladder and ureteric disorders – Irritable bowel syndrome – Cystitis – Chronic fatigue syndrome


1. Seror R, Ravaud P, Mariette X, Bootsma H, Theander E, Hansen A, et al. EULAR Sjogren's Syndrome Patient Reported Index (ESSPRI): development of a consensus patient index for primary Sjogren's syndrome. Ann Rheum Dis. 2011;70:968–972. doi: 10.1136/ard.2010.143743 21345815

2. Stefanski AL, Tomiak C, Pleyer U, Dietrich T, Burmester GR, Dorner T. The Diagnosis and Treatment of Sjogren's Syndrome. Dtsch Arztebl Int. 2017;114:354–361. doi: 10.3238/arztebl.2017.0354 28610655

3. Tarhan. Increased Overactive Bladder Symptoms in Primary Sjogren’s Syndrome. World J Nephrol Urol. 2013;2:10–14.

4. Patnaik SS, Lagana AS, Vitale SG, Buttice S, Noventa M, Gizzo S, et al. Etiology, pathophysiology and biomarkers of interstitial cystitis/painful bladder syndrome. Arch Gynecol Obstet. 2017;295:1341–1359. doi: 10.1007/s00404-017-4364-2 28391486

5. van de Merwe JP. Interstitial cystitis and systemic autoimmune diseases. Nat Clin Pract Urol. 2007;4:484–491. doi: 10.1038/ncpuro0874 17823601

6. de Merwe Van J, Kamerling R, Arendsen E, Mulder D, Hooijkaas H. Sjögren's syndrome in patients with interstitial cystitis. J Rheumatol. 1993;20:962–966. 8350331

7. Darrieutort-Laffite C, Andre V, Hayem G, Saraux A, Le Guern V, Le Jeunne C, et al. Sjogren's syndrome complicated by interstitial cystitis: A case series and literature review. Joint Bone Spine. 2015;82:245–250. doi: 10.1016/j.jbspin.2014.12.007 25680227

8. Van De Merwe J, Arendsen H. Interstitial cystitis: a review of immunological aspects of the aetiology and pathogenesis, with a hypothesis. BJU Int. 2000;85:995–999. doi: 10.1046/j.1464-410x.2000.00646.x 10792194

9. Chung KH, Liu SP, Lin HC, Chung SD. Bladder pain syndrome/interstitial cystitis is associated with anxiety disorder. Neurourol Urodyn. 2014;33:101–105. doi: 10.1002/nau.22382 24038135

10. Wang F, Jackson MW, Maughan V, Cavill D, Smith AJ, Waterman SA, et al. Passive transfer of Sjogren's syndrome IgG produces the pathophysiology of overactive bladder. Arthritis Rheum. 2004;50:3637–3645. doi: 10.1002/art.20625 15529387

11. Yamaguchi O, Shishido K, Tamura K, Ogawa T, Fujimura T, Ohtsuka M. Evaluation of mRNAs encoding muscarinic receptor subtypes in human detrusor muscle. J Urol. 1996;156:1208–1213. 8709348

12. Lee KL, Dong CS, Chen MY, Ho CH, Tai HC, Hung SF, et al. Multifactorial causes of irritating bladder symptoms in patients with Sjogren's syndrome. Neurourol Urodyn. 2011;30:97–101. doi: 10.1002/nau.20887 20928912

13. Bouchelouche K, Alvarez S, Horn T, Nordling J, Bouchelouche P. Human detrusor smooth muscle cells release interleukin-6, interleukin-8, and RANTES in response to proinflammatory cytokines interleukin-1β and tumor necrosis factor-α. Urology. 2006;67:214–219. doi: 10.1016/j.urology.2005.07.049 16413378

14. Gosens R, Rieks D, Meurs H, Ninaber DK, Rabe KF, Nanninga J, et al. Muscarinic M3 receptor stimulation increases cigarette smoke-induced IL-8 secretion by human airway smooth muscle cells. Eur Respir J. 2009;34:1436–1443. doi: 10.1183/09031936.00045209 19460789

15. Chen MC, Keshavan P, Gregory GD, Klumpp D. RANTES mediates TNF-dependent lamina propria mast cell accumulation and barrier dysfunction in neurogenic cystitis. Am J Physiol Renal Physiol. 2007;292:F1372–F1379. doi: 10.1152/ajprenal.00472.2006 17244892

16. Sant GR, Kempuraj D, Marchand JE, Theoharides TC. The mast cell in interstitial cystitis: role in pathophysiology and pathogenesis. Urology. 2007;69:S34–S40.

17. Berry SH, Elliott MN, Suttorp M, Bogart LM, Stoto MA, Eggers P, et al. Prevalence of symptoms of bladder pain syndrome/interstitial cystitis among adult females in the United States. J Urol. 2011;186:540–544. doi: 10.1016/j.juro.2011.03.132 21683389

18. Gao H, Zhang X-W, He J, Zhang J, An Y, Sun Y, et al. et al. Prevalence, risk factors, and prognosis of interstitial lung disease in a large cohort of Chinese primary Sjögren syndrome patients: A case-control study. Medicine. 2018;97:e11003. doi: 10.1097/MD.0000000000011003 29901591

19. Vriezekolk JE, Geenen R, Hartkamp A, Godaert GL, Bootsma H, Kruize AA, et al. Psychological and somatic predictors of perceived and measured ocular dryness of patients with primary Sjögren's syndrome. J Rheumatol. 2005;32:2351–2355. 16331762

20. Toker E, Yavuz Ş, Direskeneli H. Anti-Ro/SSA and anti-La/SSB autoantibodies in the tear fluid of patients with Sjögren’s syndrome. Br J Ophthalmol. 2004;88:384–387. doi: 10.1136/bjo.2003.028340 14977774

21. Zuo J, Williams AE, Park Y-J, Choi K, Chan AL, Reeves WH, et al. Muscarinic type 3 receptor autoantibodies are associated with anti-SSA/Ro autoantibodies in Sjögren's syndrome. J Immunol Methods. 2016;437:28–36. doi: 10.1016/j.jim.2016.07.003 27460476

22. Walker J, Gordon T, Lester S, Downie-Doyle S, McEvoy D, Pile K, et al. Increased severity of lower urinary tract symptoms and daytime somnolence in primary Sjögren's syndrome. J Rheumatol. 2003;30:2406–2412. 14677185

23. Pijpe J, Kalk W, Bootsma H, Spijkervet F, Kallenberg C, Vissink A. Progression of salivary gland dysfunction in patients with Sjögren’s syndrome. Ann Rheum Dis. 2007;66:107–112. doi: 10.1136/ard.2006.052647 16728458

24. Kruize A, Van Bijsterveld O, Hene R, De Wilde P, Feltkamp T, Kater L, et al. Long term course of tear gland function in patients with keratoconjunctivitis sicca and Sjögren’s syndrome. Br J Ophthalmol. 1997;81:435–438. doi: 10.1136/bjo.81.6.435 9274404

25. Pereira e Silva R, Romão V, Neves M, Garcia R, Oliveira S, Brites J, et al. Overactive bladder symptom bother and health-related quality of life in patients with systemic lupus erythematosus and primary Sjögren syndrome. Lupus. 2019;28:27–33. doi: 10.1177/0961203318811605 30419773

Článek vyšel v časopise


2019 Číslo 11