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Investigating their intricate relationship using real\u2010world data is crucial due to limited research on their connection.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and Methods<\/jats:title><jats:p>This population\u2010based cohort study included patients with endometriosis and controls without endometriosis. Propensity score matching was used to balance baseline differences in demographic and clinic characteristics between the two groups. Cox proportional hazards model were used to estimate the effect of endometriosis on the risk of new\u2010onset pSS over time. A symmetrical cohort study, including patients with pSS and propensity score\u2010matched controls without pSS, was conducted to investigate the effect of pSS on the risk of endometriosis over time. To elaborate on the mechanisms linking endometriosis and pSS, Ingenuity Pathway Analysis was performed to identify activated pathways in eutopic endometrium from patients with endometriosis and parotid tissues from patients with pSS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 15\u2009947 patients with endometriosis and 15\u2009947 propensity score\u2010matched controls without endometriosis were included. Patients with endometriosis presented a significantly greater risk of pSS compared to non\u2010endometriosis controls (adjusted hazard ratio, aHR\u2009=\u20091.57, 95% CI\u2009=\u20091.29\u20131.91, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). In the symmetrical cohort study, which included 4906 pSS patients and 4,906 propensity score\u2010matched controls without pSS, patients with pSS were found to be at a significantly higher risk of endometriosis compared to non\u2010pSS controls (aHR\u2009=\u20091.51, 95% CI\u2009=\u20091.12\u20132.04, <jats:italic>p<\/jats:italic>\u2009=\u20090.012). Ingenuity Pathway Analysis showed that the underlying cellular mechanisms involved autoimmune\u2010related pathways, including activation of dendritic cell maturation, and chronic inflammatory pathways,\u00a0including the fibrosis signaling pathway.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>These findings support a bidirectional association between endometriosis and pSS, which may be driven by dendritic cell maturation and fibrosis signaling pathways.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.14909","type":"journal-article","created":{"date-parts":[[2024,7,31]],"date-time":"2024-07-31T16:46:09Z","timestamp":1722444369000},"page":"2070-2080","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Endometriosis and Sj\u00f6gren's syndrome: Bidirectional associations in population\u2010based 15\u2010year retrospective cohorts"],"prefix":"10.1111","volume":"103","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9394-4144","authenticated-orcid":false,"given":"Kevin Sheng\u2010Kai","family":"Ma","sequence":"first","affiliation":[{"name":"Center for Global Health, Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li\u2010Tzu","family":"Wang","sequence":"additional","affiliation":[{"name":"School of Medical Laboratory Science and Biotechnology, College of Medical Science and Technology Taipei Medical University  Taipei Taiwan"},{"name":"Ph.D. Program in Medical Biotechnology, College of Medical Science and Technology Taipei Medical University  Taipei Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naoko","family":"Sasamoto","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology, and Reproductive Biology Brigham and Women's Hospital and Harvard Medical School  Boston Massachusetts USA"},{"name":"Boston Center for Endometriosis Boston Children's Hospital and Brigham and Women's Hospital  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu\u2010Hsun","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Medical Research Chung Shan Medical University Hospital  Taichung Taiwan"},{"name":"Institute of Medicine Chung Shan Medical University  Taichung Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James Cheng\u2010Chung","family":"Wei","sequence":"additional","affiliation":[{"name":"Institute of Medicine Chung Shan Medical University  Taichung Taiwan"},{"name":"Department of Allergy, Immunology &amp; Rheumatology Chung Shan Medical University Hospital  Taichung Taiwan"},{"name":"Graduate Institute of Integrated Medicine China Medical University  Taichung Taiwan"},{"name":"Office of Research and Development Asia University  Taichung Taiwan"},{"name":"Department of Nursing Chung Shan Medical University  Taichung Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4980-5710","authenticated-orcid":false,"given":"Jon Ivar","family":"Einarsson","sequence":"additional","affiliation":[{"name":"Boston Center for Endometriosis Boston Children's Hospital and Brigham and Women's Hospital  Boston Massachusetts USA"},{"name":"Division of Minimally Invasive Surgery Brigham &amp; Women's Hospital, Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marc R.","family":"Laufer","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology, and Reproductive Biology Brigham and Women's Hospital and Harvard Medical School  Boston Massachusetts USA"},{"name":"Boston Center for Endometriosis Boston Children's Hospital and Brigham and Women's Hospital  Boston Massachusetts USA"},{"name":"Division of 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