Bidirectional association between systemic lupus erythematosus and macrophage activation syndrome: A nationwide population-based study

Lu Wei Huang, James Cheng Chung Wei, Der Yuan Chen, Yen Ju Chen, Kuo Tung Tang, Tai-Ming Ko, Hsin Hua Chen*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

To determine the bidirectional relationship between macrophage activation syndrome (MAS) and SLE. Methods: Using the 1997-2013 Taiwan National Health Insurance Research Database, we identified patients with newly diagnosed SLE from 2001 to 2013 and selected individuals without SLE from a 1 million representative population. Propensity score (PS) matching was performed to balance incident SLE patients and individuals without SLE according to age, sex, comorbidities and medical utilization. The association between a history of MAS and SLE was studied using conditional logistic regression analysis shown as an adjusted odds ratio (aOR). The risk of MAS associated with SLE was analysed using Cox proportional regression analysis, shown as an adjusted hazard ratio (aHR), and we conducted a sensitivity analysis using various definitions of MAS. Results: We included 10 481 SLE patients and 20 962 PS-matched (1:2) non-SLE individuals. The correlation between a history of MAS and SLE did not reach statistical significance after adjustment for potential confounders [aOR 1.18 (95% CI, 0.80, 1.75)] in the age-/sex-matched populations. In the 1:2 PS-matched populations, the risk of MAS markedly increased in patients with SLE [aHR 7.18 (95% CI 4.97, 10.36)]. Other risk factors for MAS included female gender, age ≥65 years, low income, a history of inflammatory bowel disease and a history of MAS. Conclusion: This nationwide, population-based study revealed that a history of MAS was not significantly associated with SLE risk. However, the risk of MAS was markedly associated with SLE and a history of MAS.

Original languageEnglish
Pages (from-to)1123-1132
Number of pages10
JournalRheumatology (Oxford, England)
Volume61
Issue number3
DOIs
StatePublished - 1 Mar 2022

Keywords

  • autoimmune disease
  • macrophage activation syndrome
  • NHIRD
  • SLE

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