Toxoplasmosis seroprevalence in rheumatoid arthritis patients: A systematic review and meta-analysis.

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infectious disease 6157 exposure; further, infections increase the risk of developing autoimmunity [[15]]. On the other hand, infectious disease s may contribute to the development of autoimmune diseases through molecular mimicry and epitope spreading
toxoplasmosis 1784 disability. The aim of this systematic review and meta-analysis was to address the association between RA and toxoplasmosis in light of the available research.MethodsBased on the keywords, a systematic search of eight databases
toxoplasmosis 2308 from 9 articles were included for systematic review evaluation, with 1369 RA patients (46% positive toxoplasmosis ) and 2799 individuals as controls (21% positive toxoplasmosis). Then, eight articles (10 datasets) were
toxoplasmosis 2370 evaluation, with 1369 RA patients (46% positive toxoplasmosis) and 2799 individuals as controls (21% positive toxoplasmosis ). Then, eight articles (10 datasets) were used for meta-analysis (1244 rheumatoid arthritis patients
toxoplasmosis 2612 random effect model, the combined OR was 3.30 (95% CI: 2.05 to 5.30) with P < 0.0001.ConclusionAlthough toxoplasmosis could be considered as a potential risk factor for rheumatoid arthritis, more and better quality studies
toxoplasmosis 3041 CRD42017069384).SummaryAuthor summaryToxoplasma gondii is an intracellular obligatory protozoan, which causes toxoplasmosis . T. gondii infection in immunocompetent individuals is mostly asymptomatic, but it may be reactivated
toxoplasmosis 3616 determining the development of autoimmune diseases. In this study, we investigated the association between toxoplasmosis and RA.Data AvailabilityAll relevant data are within the paper and its Supporting Information files.IntroductionToxoplasmosis
toxoplasmosis 4555 infected with this parasite, are asymptomatic or show minor symptoms [[6]]. The most common symptom of toxoplasmosis in humans is lymphadenopathy that may be associated with fever, sore throat, muscle pain, fatigue, and
toxoplasmosis 4906 complications [[7]]. Myocarditis and polymyositis have been reported in immunocompetent individuals with acute toxoplasmosis [[8]]. Furthermore, toxoplasmosis may cause polyarthritis in the hand and knee joints [[9]]. Polytenosynovitis
toxoplasmosis 4940 polymyositis have been reported in immunocompetent individuals with acute toxoplasmosis [[8]]. Furthermore, toxoplasmosis may cause polyarthritis in the hand and knee joints [[9]]. Polytenosynovitis (inflammation of a tendon
toxoplasmosis 6425 systematic review and meta-analysis was to provide an updated review of data about the relationship between toxoplasmosis and RA.MethodsSearch strategyThis study was performed according to the Preferred Reporting Items for
toxoplasmosis 6767 surveyed. To begin, we searched scientific databases for all the articles on the association between toxoplasmosis and RA published up to the first of January 2018. These keywords were used alone or in combination:
toxoplasmosis 6909 first of January 2018. These keywords were used alone or in combination: “Toxoplasma gondii”, “ toxoplasmosis ”, “seroprevalence”, “prevalence”, “rheumatoid arthritis”, “rheumatoid factor”, “meta-analysis”,
toxoplasmosis 9113 according to the following criteria: (1) cohort or case-control studies about the relationship between toxoplasmosis as an exposure and rheumatoid arthritis as a disease, (2) the studies conducted only on humans, (3)
toxoplasmosis 9290 studies conducted only on humans, (3) the presence of case and control groups, (4) the studies where toxoplasmosis was diagnosed by detecting IgG and/or IgM antibodies against T. gondii in individuals with definitive
toxoplasmosis 9491 with definitive diagnosis of RA, and (5) the studies providing details on the seroprevalence rate of toxoplasmosis and RA.The exclusion criteria comprised: (1) studies that were only descriptive, (2) studies that only
toxoplasmosis 10597 was used to combine the results of the studies. Forest plot was used to indicate the prevalence of toxoplasmosis in each study and to determine pooled estimate prevalence in the studies. Odds ratios (ORs) and 95%
toxoplasmosis 10906 significance of P<0.05). OR > 1 indicates the positive effect of Toxoplasma on RA and an OR < 1 shows that toxoplasmosis has a protective effect against RA. Publication bias was examined by funnel plots and the statistical
toxoplasmosis 15043 positive antibodies in patients and controls. Finally, all the studies analyzed the relationship between toxoplasmosis and RA with respect to the percentage of seropositive and seronegative individuals (patients and controls).As
toxoplasmosis 15201 seropositive and seronegative individuals (patients and controls).As shown in Fig 2, the prevalence of toxoplasmosis in RA patients in these studies varied from 25% to 77% with an overall seroprevalence of 46% (95% CI
toxoplasmosis 15587 various studies (Fig 3).10.1371/journal.pntd.0006545.g002Fig 2Forest plot of seroprevalence rates of toxoplasmosis in rheumatoid arthritis patients.* Patients under treatment.10.1371/journal.pntd.0006545.g003Fig 3Forest
toxoplasmosis 15738 Patients under treatment.10.1371/journal.pntd.0006545.g003Fig 3Forest plot of seroprevalence rates of toxoplasmosis in controls groups.* Patients under treatment.According to Fig 4, the odds of toxoplasmosis in RA patients
toxoplasmosis 15830 rates of toxoplasmosis in controls groups.* Patients under treatment.According to Fig 4, the odds of toxoplasmosis in RA patients are 3.30 times compared to that of controls with 95% CI: 2.05 to 5.30 and P < 0.0001.
toxoplasmosis 16202 meta-analysis.10.1371/journal.pntd.0006545.g004Fig 4Forest plot of odds ratios for correlation between toxoplasmosis and rheumatoid arthritis.* Patients under treatment.Begg and Egger tests were used to evaluate publication
toxoplasmosis 16954 world’s human population and it is considered a silent threat [[29]]. Though a clear relationship between toxoplasmosis and autoimmune diseases, including RA, has not yet been well documented, a higher prevalence of anti-T.
toxoplasmosis 17438 [[30]].Although few studies were included in our meta-analysis, our findings showed that the prevalence of toxoplasmosis in the control group was 21%, which is almost in agreement with the results obtained by Dubey and Beattie
toxoplasmosis 18467 [[33]].10.1371/journal.pntd.0006545.t002Table 2Data extracted from the included studies in the meta-analysis for an association between toxoplasmosis and RA.NoReferenceNCase: RA+ (n)Control: RA- (n)RA+ & T+ (n, %)RA- & T+ (n, %)OR (95% CI)P-value1Shapira
toxoplasmosis 20029 prevalence of T. gondii in people with chronic diseases can be explained by the following reasons: 1) toxoplasmosis can contribute to the progression of chronic diseases and 2) treatment of these diseases with immunosuppressive
toxoplasmosis 20227 diseases with immunosuppressive drugs increases the susceptibility of patients to infections, including toxoplasmosis [[6]]. Recent treatments for RA patients with anti-tumor necrosis factor-α (TNF-α), which leads to
toxoplasmosis 20348 Recent treatments for RA patients with anti-tumor necrosis factor-α (TNF-α), which leads to brain toxoplasmosis , are indicative of this issue [[27], [38]]. On the other hand, some toll-like receptors (TLRs) have
toxoplasmosis 20996 the pathogenesis of many autoimmune diseases, including RA [[41]], a significant relationship between toxoplasmosis and RA can be explained.RA patients have autoantibodies and rheumatoid factors in their blood [[42]].
toxoplasmosis 21210 [[42]]. In two studies, these disease activity markers were found to have a significant relationship with toxoplasmosis , especially in high titers [[24], [25]]. This indicates that T. gondii can induce or exacerbate arthritis
toxoplasmosis 21440 [[43]–[45]].Because in the studied articles the relationship of age and sex with the prevalence of toxoplasmosis was not evaluated, we avoided the meta-analysis of these risk factors. In addition, diversity in the

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