Introduction: We explored the risk of end-stage renal disease (ESRD) among gout patients in a representative cohort in Taiwan. Methods: The primary database used was the Taiwan National Health Insurance Research Database. Subjects older than 20 years without ESRD, coronary heart disease, or stroke were included in the study. The case definition of gout in the present study was gout diagnosis and medical treatment for gout. An ESRD case was defined by the presence of chronic renal failure necessitating long-term renal replacement therapy. Multivariate Cox proportional hazards models were used to evaluate the risk of ESRD among gout patients. Results: The analysis included data of 656,108 patients who were followed up for a mean of 8.0 years. Among them, 19,963 (3.0%) patients had gout. At the end of 2008, 2,377 individuals (gout, n = 276; non-gout, n = 2,101) had ESRD, and 861 individuals (gout, n = 77, 27.9%; non-gout, n = 521, 24.8%) died due to ESRD. The rates of incidence of ESRD were 1.73 and 0.41 cases per 1,000 patient-years in the gout and non-gout groups. After adjustment for age, sex, and history of diabetes mellitus and/or hypertension, gout was associated with a hazard ratio (HR) of 1.57 for ESRD (95% confidence interval [CI], 1.38-1.79; P < 0.001). In patients with ESRD, the adjusted HR for death in patients with gout was 0.95 (0.74-1.23, P = 0.71), which was similar to the HR obtained in patients without gout. Conclusions: Gout is associated with an increased hazard for development of ESRD.

Background and purpose: We aimed to determine the prevalence of epilepsy in patients with multiple sclerosis (MS) at diagnosis, the risk of developing epilepsy after the diagnosis of MS and the relative risk of mortality associated with epilepsy.Methods: We used the UK Clinical Practice Research Data‐link to identify 2526 patients with incident MS and 9980 age‐, sex‐ and index year‐matched non‐MS controls from 1997 to 2006. Logistic regression was used to estimate odds ratios [95% confidence interval (CI)] for epilepsy and Cox regression was used to estimate hazard ratios (HRs) (95% CI) for epilepsy and mortality.Results: Patients with incident MS were on average 45 years old and 70.9% were female. At diagnosis, the prevalence of epilepsy in patients with MS was 1.30% compared with 0.57% in non‐MS controls. At diagnosis, MS was associated with an adjusted odds ratio (95% CI) of 2.11 (1.36–3.27) for pre‐existing epilepsy. Among epilepsy‐free patients, the cumulative probabilities of developing epilepsy, first recorded within 10 years of the index date, were 2.77% for patients with MS and 0.90% for controls. MS was associated with an adjusted HR (95% CI) of 6.01 (2.94–12.29) for epilepsy. Among patients with MS, epilepsy was associated with an HR (95% CI) of 2.23 (1.02–4.84) for all‐cause mortality.Conclusions: This population‐based study found an increased prevalence of epilepsy in patients with MS at diagnosis when compared with non‐MS controls and the risk of developing epilepsy was also higher following the MS diagnosis. Patients with MS with epilepsy had a higher risk of mortality compared with those without.

Objectives To estimate the prevalence of thyroid diseases and the cumulative risk of thyroid diseases during a follow‐up period after myasthenia gravis diagnosis (MG) compared with non‐MG control groups. Materials & Methods We used the Taiwan National Health Insurance Database linked to Registry of Catastrophic Illness database to identify patients with MG. The control groups were composed of those who did not have MG and were matched with the MG patients by sex, age and index date. We recorded thyroid disease histories before and after the index date. Results Our study included 5,813 MG patients and 29,025 control groups. The prevalence of thyroid diseases in the MG patients at diagnosis was 18.4%, which was nearly 3.9‐fold greater than that in the control groups. (Odds ratio [OR] 3.89, 95% Confidence interval [CI] 3.574–4.246) After excluding pre‐existing thyroid diseases, the incidence of comorbid thyroid diseases was 8.7% in the MG patients and 4% in the control groups. The MG patients had a 2.36‐fold increased risk of developing thyroid diseases compared to the control groups. (HR 2.36, 95% CI 2.10–2.66) The cumulative probabilities of developing thyroid diseases at 1,5,10 years after the index date were 21.6%, 24.9%, and 28.7%, respectively, in the MG patients, while the cumulative probabilities were and 6.5%, 8.8%, and 11.8%, respectively, in control groups (log‐rank test <.0001). Conclusions The current population‐based study showed a higher prevalence of pre‐existing thyroid diseases and a higher cumulative probability of thyroid diseases during follow‐up after MG diagnosis than in the general population.

Dravet syndrome (DS) is an uncommon epilepsy syndrome that may negatively affect the patients and their caregivers. However, reliable and valid measures of its impact on caregivers and the characteristics of patients with DS in Taiwan are lacking. This study aimed to describe the characteristics of patients with DS and concerns of their caregivers and establish a baseline frequency of disease characteristics using a cross-sectional survey in Taiwan. We assessed the caregivers of patients with DS using an online anonymous questionnaire. The seizure frequency decreased with age, although lacking statistical significance. Vaccines show no influence on the condition of patients with DS. Our findings revealed the highest impact on the domains affecting the caregivers’ daily life, including additional household tasks, symptom observation, further medical plan, and financial issues. Caregivers also expressed concerns regarding the lack of independence/constant care, seizure control, speech/communication, and impacts on siblings because of long-term care of the patients in parents’ absence. Our findings highlight the significant effects of caring for a child with DS on the lives of their caregivers in Taiwan; these findings will help raise awareness regarding the needs of these families. Furthermore, we discussed the possible pathophysiological mechanisms of associated comorbidities.

Human cytomegalovirus (HCMV) has been linked to the triggering of systemic lupus erythematosus (SLE). We proposed that B cell epitope region of HCMV phosphoprotein 65 (HCMVpp65)_422–439 mimics an endogenous antigen and initiates lupus-like autoimmunity. Amino acid homology between HCMVpp65_422-439 and TAF9_134-144 (TATA-box binding protein associated factor 9, TAF9) was investigated using a similarity search in NCBI protein BLAST program (BLASTP). A murine model was used to confirm their antigenicity and ability to induce lupus-like symptoms. HCMVpp65_422-439 induced immune responses with the presence of specific antibodies against HCMVpp65_422-439 and TAF9_134-144, as well as anti-nuclear and anti-double-stranded (ds)DNA antibodies that are characteristic of SLE. In addition, the majority of HCMVpp65_422-439 and TAF9_134-144 immunized mice developed proteinuria, and their renal pathology revealed glomerulonephritis with typical abnormalities, such as mesangial hypercellularity and immune complex deposition. Immunoglobulin eluted from the glomeruli of HCMVpp65_422-439 immunized mice showed cross-reactivity with TAF9_134-144 and dsDNA. Increased anti-TAF9 antibody activity was also observed in the sera from SLE patients compared with healthy people and disease controls. Molecular mimicry between HCMVpp65 peptide and host protein has the potential to drive lupus-like autoimmunity. This proof-of-concept study highlights the mechanisms underlying the link between HCMV infection and the induction of SLE.