Best Practice Case Studies-Case 151 Asset 4 Sjögren’s Syndrome in Patients With Fibromyalgia

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This nationwide retrospective cohort study used Taiwan’s Longitudinal Health Insurance Database to examine whether fibromyalgia increases the later risk of Sjögren’s syndrome. The researchers identified 74,853 adults newly diagnosed with fibromyalgia between 2000 and 2012 and matched them to 74,853 controls without fibromyalgia by age, sex, and index year. Sjögren’s syndrome was confirmed using diagnostic codes plus catastrophic illness certification, which required specialist review and supporting clinical/laboratory evidence.<br /><br />Over an average follow-up of 6.88 years, patients with fibromyalgia developed Sjögren’s syndrome more often than controls. The incidence rate was 3.39 versus 1.24 per 10,000 person-years, and after adjustment for comorbidities and medications, fibromyalgia was associated with a doubled risk of Sjögren’s syndrome (adjusted hazard ratio [aHR] 2.00; 95% CI 1.52–2.61). The association was especially strong in adults aged 20–49 years, where the aHR was 3.07.<br /><br />Women had a higher overall risk of Sjögren’s syndrome than men, but fibromyalgia increased risk in both sexes. Stratified analyses also showed higher risk among patients with fibromyalgia who had no comorbidities, as well as among those with depression, sleep disorder, or not using systemic steroids. NSAID use did not eliminate the association.<br /><br />The authors suggest possible shared mechanisms, including immune dysregulation, cytokine imbalance, neuroinflammation, and neuroendocrine dysfunction, as well as overlapping symptoms such as pain, fatigue, and dryness that may complicate diagnosis. They conclude that clinicians should be alert to the link between fibromyalgia and Sjögren’s syndrome, particularly in younger adults, and consider careful monitoring for autoimmune disease in fibromyalgia patients.

Meta Tag

Edition 4th Edition

Related Case 4th Edition, Case 151

Topic Rheumatology

Keywords

4th Edition

fibromyalgia

Sjögren’s syndrome

retrospective cohort study

Taiwan Longitudinal Health Insurance Database

autoimmune disease

incidence rate

adjusted hazard ratio

young adults

immune dysregulation

clinical monitoring

4th Edition, Case 151

Rheumatology