背景:一些结果支持以下假设:一组属于视神经脊髓炎谱系障碍(NMOSD)诊断标准的病理可能与结缔组织疾病(CTD)并存,患者对自身免疫疾病具有高度易感性。然而,NMOSD与风湿病之间的关系值得进一步研究,以阐明这种共存的所有临床方面。我们设计了系统评价和比例荟萃分析来估计CTD和MNOSD之间的关联。目的是帮助规划最佳战略,为这些疾病实现最显著的公共卫生利益。
方法:我们对2023年2月之前发表的文献进行了系统回顾,在四个数据库中进行了搜索:PubMed,WebofScience,Embase,和OVID。然后,我们进行了随机效应比例荟萃分析,并使用JoannaBriggs研究所核对表评估了纳入研究的偏倚风险.
结果:文献检索得出了3176篇出版物的总体结果(来自PubMed,880来自WebofScience,634来自Embase,1390来自OVID)。其中,29人被纳入本系统综述。分析招募未选择的系统性红斑狼疮(SLE)和干燥综合征(SjS)患者的研究,NMOSD重叠的合并百分比为0.6%(95%置信区间[95%CI]:0.1%-1.4%,)和6.5%(95%CI:4.7-8.6),分别。纳入有神经系统症状的风湿病患者的研究报告NMOSD的百分比更高(即,在SjS患者中,合并比例为26.5%,95%CI:5.5-54.6%,找到了)。同样,招募NMOSD患者,我们发现SjS或SLE的合并百分比分别为7.0%和3.5%。
结论:我们的研究发现,在诊断为SjS并有神经系统表现的女性风湿病患者和怀疑诊断为SjS的神经系统患者中,这两种疾病的共存更为常见。同样,在SLE中发现NMOSD较少,在混合性结缔组织疾病(MCTD)患者中很少发生。在风湿病学家和神经科医师的临床经验中应考虑这些因素,因为这两种疾病的早期诊断可能会影响免疫抑制治疗的时机和系统性残疾的预防。
BACKGROUND: Several results support the hypothesis that a group of pathologies falling within the Neuromyelitis Optica Spectrum Disorders (NMOSD) diagnostic criteria may coexist with Connective Tissue Diseases (CTD) in patients with a high susceptibility to autoimmune conditions. However, the relationship between NMOSD and rheumatologic diseases deserves further investigations to clarify all clinical aspects of this coexistence. We designed a systematic
review and a proportional meta-analysis to estimate the association between CTD and MNOSD, with the aim of helping to plan the best strategy to achieve the most significant public health benefit for these conditions.
METHODS: We conducted a systematic
review of the literature published until February 2023, searching in four databases: PubMed, Web of Science, EmBase, and OVID. Then, we conducted a random-effects proportional meta-analysis and assessed the risk of bias of the included studies using the Joanna Briggs Institute checklist.
RESULTS: The literature search yielded an overall result of 3176 publications (272 from PubMed, 880 from Web of Science, 634 from EmBase and 1390 from OVID). Of these, 29 were included in this systematic
review. Analyzing studies that recruited unselected patients with Systemic Lupus Erythematosus (SLE) and Sjogren Syndrome (SjS), the pooled percentages of NMOSD overlapping were 0.6% (95% Confidence Interval [95% CI]: 0.1%-1.4%,) and 6.5% (95% CI: 4.7-8.6), respectively. Studies enrolling rheumatologic patients with nervous system symptoms involvement reported higher percentage of NMOSD (i.e., among SjS patients, a pooled percentage of 26.5%, 95% CI: 5.5-54.6%, was found). Similarly, recruiting patients with NMOSD, we found pooled percentages of SjS or SLE respectively of 7.0% and 3.5%.
CONCLUSIONS: Our research found that the coexistence of these two disorders was more frequent in female rheumatologic patients with a SjS diagnosis with neurological manifestations and in neurologic patients for whom a SjS diagnosis was suspected. Similarly, NMOSD are less frequently found in SLE and very rarely incident in Mixed Connective Tissue Disease (MCTD) patients. These considerations should be taken into account in clinical experience of rheumatologists and neurologists, since early diagnosis of both conditions may influence the timing of immunosuppressive therapy and the prevention of systemic disabilities.