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Autoimmune disease and risk for Parkinson disease

A population-based case-control study

From the Institute of Cancer Epidemiology (K.R., S.F., J.H.O.), Danish Cancer Society, Copenhagen, Denmark; Department of Epidemiology and Environmental Sciences (B.R.), School of Public Health, University of California, Los Angeles; Channing Laboratory (E.S.S.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Epidemiology (E.S.S.), Harvard School of Public Health, Boston; and Department of Neurology (L.K.), Bispebjerg Hospital, Copenhagen.

Address correspondence and reprint requests to Ms. Kathrine Rugbjerg, Institute of Cancer Epidemiology, Danish Cancer Society, Strandboulevarden 49, DK-2100 Copenhagen, Denmark rugbjerg{at}cancer.dk

Objective: Inflammatory mediators are increased in autoimmune diseases and may activate microglia and might cause an inflammatory state and degeneration of dopaminergic neurons in the brain. Thus, we evaluated whether having an autoimmune disease increases the risk for developing Parkinson disease (PD).

Methods: A population based case-control study was conducted in Denmark of 13,695 patients with a primary diagnosis of PD recorded in the Danish National Hospital Register during the period 1986–2006. Each case was matched on year of birth and sex to 5 population controls selected at random from among inhabitants of Denmark who were alive at the date of the patient's diagnosis. The main exposure measure was a hospital diagnosis of 1 of 32 selected autoimmune diseases recorded 5 or more years before the index date in the files of the Danish Hospital Register.

Results: We observed no overall association between a diagnosis of autoimmune disease and risk for subsequent PD (odds ratio 0.96, 95% confidence interval 0.85–1.08). In a subgroup of patients with autoimmune diseases with systemic involvement, primarily rheumatoid arthritis, we saw a decrease in risk for PD of 30%.

Conclusions: Our results do not support the hypothesis that autoimmune diseases increase the risk for Parkinson disease. The decreased risk observed among patients with rheumatoid arthritis might be explained by underdiagnosis of movement disorders such as Parkinson disease in this patient group or by a protective effect of the treatment with anti-inflammatory drugs over prolonged periods.

Abbreviations: CI = confidence interval; COPD = chronic obstructive pulmonary disease; ICD-8 = International Classification of Diseases, 8th revision; NSAID = nonsteroidal anti-inflammatory drug; OR = odds ratio; PD = Parkinson disease.

Editorial, page 1434

e-Pub ahead of print on September 23, 2009, at www.neurology.org.

Supported by the NIH (ES013717).

Disclosure: Author disclosures are provided at the end of the article.

Received February 26, 2009. Accepted in final form August 5, 2009.

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