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We here investigated whether infections increase the risk of developing primary Sj\u00f6gren's syndrome (pSS<\/jats:styled-content>).<\/jats:p><\/jats:sec>Methods<\/jats:title>Patients with pSS<\/jats:styled-content> in Sweden (n<\/jats:italic>\u00a0=\u00a0945) and matched controls from the general population (n<\/jats:italic>\u00a0=\u00a09048) were included, and data extracted from the National Patient Register to identify infections occurring before pSS<\/jats:styled-content> diagnosis during a mean observational time of 16.0\u00a0years. Data were analysed using conditional logistic regression models. Sensitivity analyses were performed by varying exposure definition and adjusting for previous health care consumption.<\/jats:p><\/jats:sec>Results<\/jats:title>A history of infection associated with an increased risk of pSS<\/jats:styled-content> (OR<\/jats:styled-content> 1.9, 95% CI<\/jats:styled-content> 1.6\u20132.3). Infections were more prominently associated with the development of SSA<\/jats:styled-content>\/SSB<\/jats:styled-content> autoantibody\u2010positive pSS<\/jats:styled-content> (OR<\/jats:styled-content> 2.7, 95% CI<\/jats:styled-content> 2.0\u20133.5). When stratifying the analysis by organ system infected, respiratory infections increased the risk of developing pSS<\/jats:styled-content>, both in patients with (OR<\/jats:styled-content> 2.9, 95% CI<\/jats:styled-content> 1.8\u20134.7) and without autoantibodies (OR<\/jats:styled-content> 2.1, 95% CI<\/jats:styled-content> 1.1\u20133.8), whilst skin and urogenital infections only significantly associated with the development of autoantibody\u2010positive pSS<\/jats:styled-content> (OR<\/jats:styled-content> 3.2, 95% CI<\/jats:styled-content> 1.8\u20135.5 and OR<\/jats:styled-content> 2.7, 95% CI<\/jats:styled-content> 1.7\u20134.2). Furthermore, a dose\u2013response relationship was observed for infections and a risk to develop pSS<\/jats:styled-content> with Ro\/SSA<\/jats:styled-content> and La\/SSB<\/jats:styled-content> antibodies. Gastrointestinal infections were not significantly associated with a risk of pSS<\/jats:styled-content>.<\/jats:p><\/jats:sec>Conclusions<\/jats:title>Infections increase the risk of developing pSS<\/jats:styled-content>, most prominently SSA<\/jats:styled-content>\/SSB<\/jats:styled-content> autoantibody\u2010positive disease, suggesting that microbial triggers of immunity may partake in the pathogenetic process of pSS<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/joim.12888","type":"journal-article","created":{"date-parts":[[2019,3,20]],"date-time":"2019-03-20T10:31:00Z","timestamp":1553077860000},"page":"670-680","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Infections increase the risk of developing Sj\u00f6gren's syndrome"],"prefix":"10.1111","volume":"285","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1873-7169","authenticated-orcid":false,"given":"J.","family":"Mofors","sequence":"first","affiliation":[{"name":"Division of Rheumatology Department of Medicine Solna Karolinska Institutet Karolinska University Hospital Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. 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Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H.","family":"Forsblad\u2010d'Elia","sequence":"additional","affiliation":[{"name":"Department of Public Health and Clinical Medicine Rheumatology Ume\u00e5 University Ume\u00e5 Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Magnusson Bucher","sequence":"additional","affiliation":[{"name":"Department of Rheumatology Faculty of Medicine and Health \u00d6rebro University \u00d6rebro Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Eriksson","sequence":"additional","affiliation":[{"name":"Division of Rheumatology Department of Clinical Experimental Medicine Link\u00f6ping University Link\u00f6ping Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T.","family":"Mandl","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Malm\u00f6 Rheumatology Lund University Malm\u00f6 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