The association between neurological diseases, malignancies and cardiovascular comorbidities among patients with bullous pemphigoid: Case-control study in a specialized Polish center

Background: Bullous pemphigoid (BP) is the most common autoimmune bullous disease associated with higher mortality and coexisting comorbidities. The strongest relationship has been reported with neurological diseases (NDs) but the particular type of ND differed depending on the study. There are some doubts on the prevalence of other comorbidities.

Objectives: The aim of this study was to compare the incidence of various comorbidities in a cohort of BP patients with controls.

Material and methods: A cohort of 218 patients (137 females, 81 males, aged 76.2 ±11.6 years) with newly diagnosed BP who were hospitalized at a specialized center in Poland in the years 2000-2014 was included in this retrospective study. The controls consisted of 168 sexand age-matched individuals. Univariate and multivariate logistic regression analyses were performed to assess the association between the groups studied.

Results: At least 1 ND was present in 33.5% of BP patients vs 11.3% of controls. A strong association between the incidence of NDs and BP was found (OR = 3.76; 95% CI = 2.13-6.65; p < 0.001), especially for dementia (20.6% vs 2.9%, OR = 7.89; 95% CI = 2.99-20.85; p < 0.001). Surprisingly, BP patients with ND were older than the BP patients without ND (79.2 vs 74.7 years), and similarly for dementia (81.08 vs 74.90 years). The same was observed in comparison with controls. Arterial hypertension, among other comorbidities, was a strong independent factor associated with BP (OR = 2.17; 95% CI = 1.35-3.49; p < 0.001). Malignancies were observed more frequently in BP patients than in controls (12.8% vs 9%) but such association was significant in univariate analysis only.

Conclusions: Neurological diseases, particularly dementia, had a significant association with BP. A strong relationship with arterial hypertension and weak relationship with malignancies were noted. Thus, for appropriate medical care, patients with BP need accurate screening for dementia and control of comorbidities with interdisciplinary management.