Kridin K, et al. - Researchers pursued a comprehensive analysis of the connection between pemphigus and 4 neurologic conditions (dementia, epilepsy, Parkinson's disease, and multiple sclerosis), using one of the largest cohorts of patients with pemphigus. Pemphigus illustrated a correlation with specific neurologic diseases, including dementia, Parkinson's disease, and epilepsy. Physicians treating patients with pemphigus were cautioned regarding this potential link. Data also recommended careful evaluation of pemphigus patients for comorbid neurologic disorders. Furthermore, subjects ought to receive appropriate treatment.

Methods

• The scheme of this research was a retrospective population-based cross-sectional study.
• It was carried out between January 1, 2004, and December 31, 2014 using the database of Clalit Health Services, the largest public health care organization in Israel, in the setting of general community clinics, primary care and referral centers, and ambulatory and hospitalized care.
• The enrollment comprised of 1,985 patients with a new diagnosis of pemphigus and 9,874 controls.
• Main outcome measures included the proportion of dementia, epilepsy, Parkinson's disease, and multiple sclerosis was compared between patients diagnosed with pemphigus and age-, sex-, and ethnicity-matched control participants.
• Using Logistic regression, the odds ratios (ORs) for dementia, epilepsy, Parkinson's disease, and multiple sclerosis were computed.
• A scrutiny was performed of the association after a sensitivity analysis that included only patients treated with long-term, pemphigus-specific medications (corticosteroids, immunosuppressants, or rituximab) and after adjustment for several confounding factors.

Results

• By contrasting 1,985 cases (1188 women and 797 men; mean [SD] age, 72.1 [18.5] years) with the 9,874 controls (5,912 women and 3,962 men; mean [SD] age, 72.1 [18.5] years), dementia was found in 622 cases (31.3%) vs 1,856 controls (18.8%), with an OR of 1.97 (95% CI, 1.77-2.20).
• The presence of epilepsy was noted in 74 cases (3.7%) vs 210 controls (2.1%), with an OR of 1.78 (95% CI, 1.36-2.33).
• Data revealed Parkinson's disease in 175 cases (8.8%) vs 437 controls (4.4%), with an OR of 2.09 (95% CI, 1.74-2.51).
• Two cases reported multiple sclerosis (0.1%) compared to 6 controls (0.01%), with an OR of 1.65 (95% CI, 0.34-8.22).
• Robust study findings were demonstrated to the sensitivity analysis which constituted subjects receiving pemphigus-specific treatments.
• As per the outcomes, estimates did not exhibit prominent alteration after controlling for comorbidities and overuse of health care.