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Risk of systemic lupus erythematosus in patients with idiopathic thrombocytopenic purpura: a population-based cohort study
  1. Fang-Xiao Zhu1,
  2. Jing-Yang Huang2,3,
  3. Zhizhong Ye4,
  4. Qing-Qing Wen1,
  5. James Cheng-Chung Wei5,6,7,8,9
  1. 1 Department of Rheumatology and Immunology, The Second Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China
  2. 2 Department of Medical Research, Chung Shan Medical University Hospital, Taichung City, Taiwan, Taiwan
  3. 3 Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
  4. 4 Department of Rheumatology, Shenzhen Futian Hospital for Rheumatic Diseases, Shenzhen, Guangdong, China
  5. 5 Department of Rheumatology, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China
  6. 6 Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
  7. 7 Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
  8. 8 Chung Shan Medical University Hospital, Taichung, Taiwan
  9. 9 Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
  1. Correspondence to Dr James Cheng-Chung Wei, Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; jccwei{at}


Background Idiopathic thrombocytopenic purpura (ITP) may play a role in early-stage systemic lupus erythematosus (SLE). The incidence of SLE in patients with ITP and the potential relationship between them is still unclear. This study was performed to provide epidemiological evidence regarding the relationship between ITP and SLE occurrence.

Methods In this population-based retrospective cohort study, the risk of SLE was analysed in a cohort of patients newly diagnosed with ITP between 2000 and 2013. Controls were selected at a 1:2 ratio through propensity score matching (PSM) using the greedy algorithm. The Cox proportional hazard model was used to analyse the association between ITP and SLE incidence. There were four different Cox regression models, and the sensitivity analyses were implemented to evaluate the HR of SLE after exposure with ITP.

Results In the age-matched and sex-matched ITP and non-ITP cohort, the average follow-up time was about 80 months in this study. There were 34 (4.70%) and 27 (0.19%) incident cases of SLE in ITP and non-ITP group. The incidence rates were 62.0 (95% CI 44.3 to 86.8) and 2.10 (95% CI 1.44 to 3.06), respectively. The adjusted HR of incidental SLE in the ITP group was 25.1 (95% CI 13.7 to 46.0). The other risk factors for SLE were female sex and Sjogren’s syndrome. After PSM, the incidence rate and Kaplan-Meir curves of SLE were consistent with the results for the age-matched and sex-matched population, the HR 17.4 (95% CI 5.28 to 57.4) was estimated by conditional Cox model.

Conclusion This cohort study demonstrated that patients with ITP have a higher risk of SLE. Clinically, patients with ITP should be monitored for incidental lupus.

  • systemic lupus erythematosus
  • autoimmune diseases
  • epidemiology

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  • Handling editor Josef S Smolen

  • Contributors F-XZ analysed the data, generated figures and wrote the manuscript. J-YH, ZY and Q-QW performed bioinformatics analysis and wrote the manuscript. JC-CW made substantial contributions to the design of the study, conducted data analysis and figure generation, and wrote the manuscript. All authors read and approved the final manuscript.

  • Funding The present study was supported by the Programme of Scientific and Technology Project (Guilin Science Research and Technology Development; grant no. 2016012706–2).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by Chung Shan Medical University Hospital (IRB, CS15134).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as online supplementary information. Please fix the following issues then click Save or Save & Continue:Permissions—images is a required field.

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