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International journal of rheumatic diseases
Aug, 2022;25 (8): 937-944.

No increased risk of alopecia in ankylosing spondylitis patients: A population-based cohort study in Taiwan.

Jason Peijer Hsieh, Yung-Heng Lee, Bo-Jyun Wun, Yu-Hsun Wang, Hsi-Kai Tsou, James Cheng-Chung Wei
Author Information
  1. Jason Peijer Hsieh: Department of Orthopedics, Taipei Veterans General Hospital, Taipei, Taiwan ROC.
  2. Yung-Heng Lee: Department of Senior Services Industry Management, Minghsin University of Science and Technology, Hsinchu, Taiwan ROC.
  3. Bo-Jyun Wun: School of Medicine, Chung Shan Medical University, Taichung, Taiwan ROC. ORCID
  4. Yu-Hsun Wang: Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan ROC.
  5. Hsi-Kai Tsou: Functional Neurosurgery Division, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan ROC.
  6. James Cheng-Chung Wei: Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan ROC. ORCID
PMID: 35880581 DOI: 10.1111/1756-185X.14393

Abstract

AIM: To investigate the association between ankylosing spondylitis (AS) and alopecia.
METHODS: In this cohort study, data from over 1 000 000 patients in the Taiwan Longitudinal Health Insurance Database were extracted. We selected newly diagnosed (outpatient department visit three or more times or admission at least once) patients with AS (ICD-9-CM = 720.0) from 2000 to 2012. For the non-AS comparison group, patients never diagnosed with AS were chosen from 1999 to 2013. In all, 3640 AS patients and 14 560 non-AS controls were selected. Cox proportional hazard model and Kaplan-Meier analysis were used to present the results. The adjusted hazard ratio (HR) in the Cox proportional hazard model was adjusted for age, sex, hypertension, hyperlipidemia, diabetes, atopic dermatitis, and mental disorder.
RESULTS: No increased risk of alopecia in AS patients was shown in the Cox proportional hazard model (crude HR 1.16, P = 0.595; adjusted HR 1.16, P = 0.599). Negative results are found as well in subgroup analysis of different age, sex (age 20-40 y: HR 1.03, P = 0.925; Age ≥40 y: HR 1.49, P = 0.406; Female: HR 1.17, P = 0.759; Male: HR 1.15, P = 0.667), and phenotypes of alopecia (androgenetic alopecia: HR 1.19, 95% confidence interval [CI] 0.58-2.41; alopecia areata: HR 0.98, 95% CI 0.37-2.62). A significant positive correlation is found between atopic dermatitis and alopecia (adjusted HR 8.05, P = 0.039).
CONCLUSION: In this population-based cohort study, we found no association of risk of alopecia and AS.

Keywords

alopecia ankylosing spondylitis autoimmune diseases cohort study skin

References

Yang H, Chen Y, Xu W, et al. Epigenetics of ankylosing spondylitis: recent developments. Int J Rheum Dis. 2021;24(4):487-493.
Meer E, Thrastardottir T, Wang X, et al. Risk factors for diagnosis of psoriatic arthritis, psoriasis, rheumatoid arthritis, and ankylosing spondylitis: a set of parallel case-control studies. J Rheumatol. 2022;49(1):53-59.
Zochling J, Smith EU. Seronegative spondyloarthritis. Best Pract Res Clin Rheumatol. 2010;24(6):747-756.
Gooren LJ, Giltay EJ, van Schaardenburg D, Dijkmans BA. Gonadal and adrenal sex steroids in ankylosing spondylitis. Rheum Dis Clin North Am. 2000;26(4):969-987.
Mease PJ, McLean RR, Dube B, et al. Comparison of Men and Women With axial spondyloarthritis in the US-based corrona psoriatic arthritis/spondyloarthritis registry. J Rheumatol. 2021;48(10):1528-1536.
Madani S, Shapiro J. Alopecia areata update. J Am Acad Dermatol. 2000;42(4):549-566; quiz 67-70.
Pratt CH, King LE Jr, Messenger AG, Christiano AM, Sundberg JP. Alopecia areata. Nat Rev Dis Primers. 2017;3:17011.
Simakou T, Butcher JP, Reid S, Henriquez FL. Alopecia areata: a multifactorial autoimmune condition. J Autoimmun. 2019;98:74-85.
Hordinsky M, Ericson M. Autoimmunity: alopecia areata. J Investig Dermatol Symp Proc. 2004;9(1):73-78.
Barahmani N, Schabath MB, Duvic M. History of atopy or autoimmunity increases risk of alopecia areata. J Am Acad Dermatol. 2009;61(4):581-591.
Thomas EA, Kadyan RS. Alopecia areata and autoimmunity: a clinical study. Indian J Dermatol. 2008;53(2):70-74.
Goh C, Finkel M, Christos PJ, Sinha AA. Profile of 513 patients with alopecia areata: associations of disease subtypes with atopy, autoimmune disease and positive family history. J Eur Acad Dermatol Venereol. 2006;20(9):1055-1060.
Ito T. Recent advances in the pathogenesis of autoimmune hair loss disease alopecia areata. Clin Dev Immunol. 2013;2013:348546.
Chang YJ, Lee YH, Leong PY, Wang YH, Wei JC. Impact of rheumatoid arthritis on alopecia: a nationwide population-based cohort study in Taiwan. Front Med (Lausanne). 2020;7:150.
Pan Y, Rao NA. Alopecia areata during etanercept therapy. Ocul Immunol Inflamm. 2009;17(2):127-129.
Ferran M, Calvet J, Almirall M, Pujol RM, Maymó J. Alopecia areata as another immune-mediated disease developed in patients treated with tumour necrosis factor-α blocker agents: report of five cases and review of the literature. J Eur Acad Dermatol Venereol. 2011;25(4):479-484.
Tauber M, Buche S, Reygagne P, et al. Alopecia areata occurring during anti-TNF therapy: a national multicenter prospective study. J Am Acad Dermatol. 2014;70(6):1146-1149.
Pelivani N, Hassan AS, Braathen LR, Hunger RE, Yawalkar N. Alopecia areata universalis elicited during treatment with adalimumab. Dermatology. 2008;216(4):320-323.
Katoulis AC, Alevizou A, Bozi E, et al. Biologic agents and alopecia areata. Dermatology. 2009;218(2):184-185.
Lazzarini R, Capareli GC, Buense R, Lellis RF. Alopecia universalis during treatment with leflunomide and adalimumab - case report. An Bras Dermatol. 2014;89(2):320-322.
Giltay EJ, van Schaardenburg D, Gooren LJ, Popp-Snijders C, Dijkmans BA. Androgens and ankylosing spondylitis: a role in the pathogenesis? Ann N Y Acad Sci. 1999;876:340-364; discussion 65, 365.
Gracey E, Yao Y, Green B, et al. Sexual dimorphism in the Th17 signature of ankylosing spondylitis. Arthritis Rheumatol. 2016;68(3):679-689.
James WH. Sex ratios and hormones in HLA related rheumatic diseases. Ann Rheum Dis. 1991;50(6):401-404.
Jeong H, Bae EK, Kim H, et al. Estrogen attenuates the spondyloarthritis manifestations of the SKG arthritis model. Arthritis Res Ther. 2017;19(1):198.
Jethwa H, Bowness P. The interleukin (IL)-23/IL-17 axis in ankylosing spondylitis: new advances and potentials for treatment. Clin Exp Immunol. 2016;183(1):30-36.
Evans DM, Spencer CC, Pointon JJ, et al. Interaction between ERAP1 and HLA-B27 in ankylosing spondylitis implicates peptide handling in the mechanism for HLA-B27 in disease susceptibility. Nat Genet. 2011;43(8):761-767.
Caffrey MF, James DC. Human lymphocyte antigen association in ankylosing spondylitis. Nature. 1973;242(5393):121.
Jadon D, Tillett W, Wallis D, et al. Exploring ankylosing spondylitis-associated ERAP1, IL23R and IL12B gene polymorphisms in subphenotypes of psoriatic arthritis. Rheumatology (Oxford). 2013;52(2):261-266.
Rueda B, Orozco G, Raya E, et al. The IL23R Arg381Gln non-synonymous polymorphism confers susceptibility to ankylosing spondylitis. Ann Rheum Dis. 2008;67(10):1451-1454.
Cortes A, Hadler J, Pointon JP, et al. Identification of multiple risk variants for ankylosing spondylitis through high-density genotyping of immune-related loci. Nat Genet. 2013;45(7):730-738.
Sagiv M, Adawi M, Awisat A, et al. The association between elevated serum interleukin-22 and the clinical diagnosis of axial spondyloarthritis: a retrospective study. Int J Rheum Dis. 2022;25(1):56-60.
Suárez-Fariñas M, Ungar B, Noda S, et al. Alopecia areata profiling shows TH1, TH2, and IL-23 cytokine activation without parallel TH17/TH22 skewing. J Allergy Clin Immunol. 2015;136(5):1277-1287.
Waśkiel-Burnat A, Osińska M, Salińska A, et al. The role of serum Th1, Th2, and Th17 cytokines in patients with alopecia areata: clinical implications. Cell. 2021;10(12):3397.
Philpott MP, Sanders DA, Bowen J, Kealey T. Effects of interleukins, colony-stimulating factor and tumour necrosis factor on human hair follicle growth in vitro: a possible role for interleukin-1 and tumour necrosis factor-alpha in alopecia areata. Br J Dermatol. 1996;135(6):942-948.
Wei JC, Liu CH, Tseng JC, et al. Taiwan rheumatology association consensus recommendations for the management of axial spondyloarthritis. Int J Rheum Dis. 2020;23(1):7-23.
Andersen YM, Egeberg A, Gislason GH, Skov L, Thyssen JP. Autoimmune diseases in adults with atopic dermatitis. J Am Acad Dermatol. 2017;76(2):274-80.e1.
Mohan GC, Silverberg JI. Association of vitiligo and alopecia areata with atopic dermatitis: a systematic review and meta-analysis. JAMA Dermatol. 2015;151(5):522-528.
Smogorzewski J, Sierro T, Compoginis G, Kim G. Remission of alopecia universalis in a patient with atopic dermatitis treated with dupilumab. JAAD Case Rep. 2019;5(2):116-117.
Krupa Shankar D, Chakravarthi M, Shilpakar R. Male androgenetic alopecia: population-based study in 1,005 subjects. Int J Trichology. 2009;1(2):131-133.

MeSH Term

Alopecia Areata
Cohort Studies
Dermatitis, Atopic
Female
Humans
Incidence
Male
Proportional Hazards Models
Retrospective Studies
Risk Factors
Spondylitis, Ankylosing
Taiwan
Journal Article

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