Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
JCR Impact Factor (IF) – 1.736
5-Year Impact Factor – 2.135
Index Copernicus  – 168.52
MEiN – 70 pts

ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
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Advances in Clinical and Experimental Medicine

2019, vol. 28, nr 5, May, p. 637–642

doi: 10.17219/acem/90922

Publication type: original article

Language: English

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The association between neurological diseases, malignancies and cardiovascular comorbidities among patients with bullous pemphigoid: Case-control study in a specialized Polish center

Agnieszka Kalińska-Bienias1,A,B,C,D,E,F, Emilia Kowalczyk1,B,C,D, Paweł Jagielski2,C, Piotr Bienias3,C,D, Cezary Kowalewski1,A,E, Katarzyna Woźniak1,A,B,C,D,E,F

1 Department of Dermatology and Immunodermatology, Medical University of Warsaw, Poland

2 Human Nutrition Department, Faculty of Health Sciences, Jagiellonian University Medical College, Kraków, Poland

3 Department of Internal Medicine and Cardiology, Medical University of Warsaw, Poland

Abstract

Background. Bullous pemphigoid (BP) is the most common autoimmune bullous disease associated with higher mortality and coexisting comorbidities. The strongest relationship has been reported with neurological diseases (NDs) but the particular type of ND differed depending on the study. There are some doubts on the prevalence of other comorbidities.
Objectives. The aim of this study was to compare the incidence of various comorbidities in a cohort of BP patients with controls.
Material and Methods. A cohort of 218 patients (137 females, 81 males, aged 76.2 ±11.6 years) with newly diagnosed BP who were hospitalized at a specialized center in Poland in the years 2000–2014 was included in this retrospective study. The controls consisted of 168 sexand age-matched individuals. Univariate and multivariate logistic regression analyses were performed to assess the association between the groups studied.
Results. At least 1 ND was present in 33.5% of BP patients vs 11.3% of controls. A strong association between the incidence of NDs and BP was found (OR = 3.76; 95% CI = 2.13–6.65; p < 0.001), especially for dementia (20.6% vs 2.9%, OR = 7.89; 95% CI = 2.99–20.85; p < 0.001). Surprisingly, BP patients with ND were older than the BP patients without ND (79.2 vs 74.7 years), and similarly for dementia (81.08 vs 74.90 years). The same was observed in comparison with controls. Arterial hypertension, among other comorbidities, was a strong independent factor associated with BP (OR = 2.17; 95% CI = 1.35–3.49; p < 0.001). Malignancies were observed more frequently in BP patients than in controls (12.8% vs 9%) but such association was significant in univariate analysis only.
Conclusion. Neurological diseases, particularly dementia, had a significant association with BP. A strong relationship with arterial hypertension and weak relationship with malignancies were noted. Thus, for appropriate medical care, patients with BP need accurate screening for dementia and control of comorbidities with interdisciplinary management.

Key words

comorbidities, neurological diseases, bullous pemphigoid, internal diseases

References (33)

  1. Langan SM, Groves RW, West J. The relationship between neurological disease and bullous pemphigoid: A population-based case-control study. J Invest Dermatol. 2011;131(3):631–636.
  2. Brick KE, Weaver CH, Savica R, et al. A population-based study of the association between bullous pemphigoid and neurologic disorders. J Am Acad Dermatol. 2014;71(6):1191–1197.
  3. Serwin AB, Musialkowska E, Piascik M. Incidence and mortality of bullous pemphigoid in north-east Poland (Podlaskie Province), 1999–2012: A retrospective bicentric cohort study. Int J Dermatol. 2014; 53(10):e432–437.
  4. Kalinska-Bienias A, Lukowska-Smorawska K, Jagielski P, Kowalewski C, Wozniak K. Mortality in bullous pemphigoid and prognostic factors in 1st and 3rd year of follow-up in specialized centre in Poland. Arch Dermatol Res. 2017;309(9):709–719.
  5. Taghipour K, Chi CC, Vincent A, Groves RW, Venning V, Wojnarowska F. The association of bullous pemphigoid with cerebrovascular disease and dementia: A case-control study. Arch Dermatol. 2010;146(11):1251–1254.
  6. Bastuji-Garin S, Joly P, Lemordant P, et al; French Study Group for Bullous Diseases. Risk factors for bullous pemphigoid in the elderly: A prospective case-control study. J Invest Dermatol. 2011;131(3):637–643.
  7. Jedlickova H, Hlubinka M, Pavlik T, Semradova V, Budinska E, Vlasin Z. Bullous pemphigoid and internal diseases: A case-control study. Eur J Dermatol. 2010;20(1):96–101.
  8. Cordel N, Chosidow O, Hellot MF, et al; French Study Group for Bullous Diseases. Neurological disorders in patients with bullous pemphigoid. Dermatology. 2007;215(3):187–191.
  9. Yu Phuan CZ, Yew YW, Tey HL. Bullous pemphigoid and antecedent neurological diseases: An association with dementia. Indian J Dermatol Venereol Leprol. 2017;83(4):457–461.
  10. Chen YJ, Wu CY, Lin MW, et al. Comorbidity profiles among patients with bullous pemphigoid: A nationwide population-based study. Br J Dermatol. 2011;165(3):593–599.
  11. Daneshpazhooh M, Khorassani J, Balighi K, et al. Neurological diseases and bullous pemphigoid: A case-control study in Iranian patients. Indian J Dermatol Venereol Leprol. 2017;83(2):195–199.
  12. Casas-de-la-Asuncion E, Ruano-Ruiz J, Rodriguez-Martin AM, Rodriguez-Martin AM, Velez Garcia-Nieto A, Moreno-Gimenez JC. Association between bullous pemphigoid and neurologic diseases: A case-control study. Actas Dermosifiliogr. 2014;105(9):860–865.
  13. Kwan Z, Lai YN, Ch’ng CC, et al. The association between bullous pemphigoid and neurological disorders in a selected Malaysian population. Med J Malaysia. 2015;70(2):81–85.
  14. Lai YC, Yew YW, Lambert WC. Bullous pemphigoid and its association with neurological diseases: A systematic review and meta-analysis. J Eur Acad Dermatol Venereol. 2016;30(12):2007–2015.
  15. Forsti AK, Jokelainen J, Ansakorpi H, et al. Psychiatric and neurological disorders are associated with bullous pemphigoid – a nationwide Finnish Care Register study. Sci Rep. 2016;6:37125.
  16. Ong E, Goldacre R, Hoang U, Sinclair R, Goldacre M. Associations between bullous pemphigoid and primary malignant cancers: An English national record linkage study, 1999–2011. Arch Dermatol Res. 2014;306(1):75–80.
  17. Iwashita K, Matsuyama T, Akasaka E, et al. The incidence of internal malignancies in autoimmune bullous diseases. Tokai J Exp Clin Med. 2007;32(1):42–47.
  18. Ogawa H, Sakuma M, Morioka S, et al. The incidence of internal malignancies in pemphigus and bullous pemphigoid in Japan. J Dermatol Sci. 1995;9(2):136–141.
  19. Schulze F, Neumann K, Recke A, Zillikens D, Linder R, Schmidt E. Malignancies in pemphigus and pemphigoid diseases. J Invest Dermatol. 2015;135(5):1445–1447.
  20. Cai SC, Allen JC, Lim YL, Tan SH, Tang MB. Association of bullous pemphigoid and malignant neoplasms. JAMA Dermatol. 2015;151(6): 665–667.
  21. Kremer N, Zeeli T, Sprecher E, Geller S. Failure of initial disease control in bullous pemphigoid: A retrospective study of hospitalized patients in a single tertiary center. Int J Dermatol. 2017;56(10):1010–1016.
  22. Sim B, Fook-Chong S, Phoon YW, et al. Multimorbidity in bullous pemphigoid: A case-control analysis of bullous pemphigoid patients with age- and gender-matched controls. J Eur Acad Dermatol Venereol. 2017;31(10):1709–1714. doi:10.1111/jdv.14312
  23. Kibsgaard L, Bay B, Deleuran M, Vestergaard C. A retrospective consecutive case-series study on the effect of systemic treatment, length of admission time, and co-morbidities in 98 bullous pemphigoid patients admitted to a tertiary centre. Acta Derm Venereol. 2015;95(3):307–311.
  24. Chuang TY, Korkij W, Soltani K, Clayman J, Cook J. Increased frequency of diabetes mellitus in patients with bullous pemphigoid: A case-control study. J Am Acad Dermatol. 1984;11(6):1099–1102.
  25. Li J, Zuo YG, Zheng HY, Qiu-Ning S. Association between bullous pemphigoid and internal diseases. J Dtsch Dermatol Ges. 2013;11(3):263–264.
  26. Pietkiewicz P, Gornowicz-Porowska J, Bowszyc-Dmochowska M, Bartkiewicz P, Dmochowski M. Bullous pemphigoid and neurodegenerative diseases: A study in a setting of a Central European university dermatology department. Aging Clin Exp Res. 2016;28(4):659–663.
  27. Tarazona MJ, Mota AN, Gripp AC, Unterstell N, Bressan AL. Bullous pemphigoid and neurological disease: Statistics from a dermatology service. An Bras Dermatol. 2015;90(2):280–282.
  28. Gambichler T, Segert H, Hoxtermann S, Schmitz L, Altmeyer P, Teegen B. Neurological disorders in patients with bullous pemphigoid: Clinical and experimental investigations. J Eur Acad Dermatol Venereol 2015;29(9):1758–1762.
  29. Messingham KA, Aust S, Helfenberger J, et al. Autoantibodies to collagen XVII are present in Parkinson’s disease and localize to tyrosine-hydroxylase positive neurons. J Invest Dermatol. 2016;136(3):721–723.
  30. Kokkonen N, Herukka S-K, Huilaja L, et al. Increased levels of the bullous pemphigoid BP180 autoantibody are associated with more severe dementia in Alzheimer’s disease. J Invest Dermatol. 2017;137(1):71–76.
  31. Lindelof B, Islam N, Eklund G, Arfors L. Pemphigoid and cancer. Arch Dermatol. 1990;126(1):66–68.
  32. Balestri R, Magnano M, La Placa M, et al. Malignancies in bullous pemphigoid: A controversial association. J Dermatol. 2016;43(2):125–133.
  33. Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013;34(28):2159–2219.
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