Late-Onset Rheumatoid Arthritis and Air Pollution in the Multiethnic Cohort.

The geographic variation in rheumatoid arthritis (RA) incidence in the United States is unknown. We studied residential region from January 1, 1921, to May 31, 1976, and RA risk in a prospective cohort of women, the Nurses' Health Study. Information on state of residence was collected at baseline in 1976 (when participants were aged 30-55 years) and on state of residence at birth, at age 15 years, and at age 30 years in 1992. Among 83,546 participants reporting residence for all 4 time points, 706 incident RA cases from June 1, 1976, to May 31, 2004, were confirmed by screening questionnaire and record review for American College of Rheumatology criteria. Residential region was classified as West, Midwest, mid-Atlantic, New England, and Southeast. Multivariate Cox proportional hazards regression models were used to assess relationships between region and RA risk, adjusting for age, smoking, body mass index, parity, breastfeeding, postmenopausal status, postmenopausal hormone use, father's occupation, race, and physical activity. Analyses were performed in participants who lived in the same regions, or moved, over time. Compared with those in the West, women in New England had a 37% to 45% elevated risk of RA in multivariate models at each time point (eg, state of residence in 1976: rate ratio [RR], 1.42; 95% confidence interval [CI], 1.10-1.82). In analyses of women who lived in the same region at birth, age 15 years, and age 30 years, living in the Midwest was associated with greater risk (RR, 1.47; 95% CI, 1.05-2.05), as was living in New England (RR, 1.40; 95% CI, 0.98-2.00). Compared with living in the West at birth, age 15 years, and age 30 years, RA risk was higher in the East. In this large cohort of US women, significant geographic variation in incident RA existed after controlling for confounders. Potential explanations include regional variation in behavioral factors, climate, environmental exposures, RA diagnosis, and genetic factors.

Background There is a recognized excess burden of cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA) as compared to the general population. Several studies suggested reduced CVD mortality in RA in recent decades [1-3]. Longitudinal studies on trends in occurrence of CVD events in RA patients over time, and studies comparing trends in CVD events in RA vs general population are lacking. Objectives 1) To assess trends in incidence of CVD in patients with incident RA in 1980-2009; and 2) To compare incidence of CVD in RA patients vs non-RA subjects with RA incidence/index date in 2000-09. Methods The study population comprised Olmsted County, Minnesota residents with incident RA (age >18 years, 1987 ACR criteria met in 1980-2009) and non-RA subjects from the same underlying population with similar age, sex and calendar year of index. All subjects were followed until death, migration, or 12/31/2016. Follow-up was truncated for comparability. Incident CVD events included myocardial infarction (MI), stroke (ischemic or hemorrhagic), coronary heart disease (CHD) death and first occurrence of any of these. Patients with CVD events prior to RA incidence/index date were excluded. Cox proportional hazards models were used to compare incident CVD events by decade, adjusting for age and sex. Cumulative incidence of CVD events adjusted for death from other causes was also computed. Results The study included 906 patients with RA (mean age 55.9 years; 69% female). There were 201, 299 and 406 patients with incident RA in 1980-89, 1990-99 and 2000-09, respectively. During median follow-up of 10.6, 10.4 and 10.2 years per decade, CVD events occurred in 31, 38, and 31 patients. Patients with incident RA in 2000–09 had markedly lower cumulative incidence of any CVD events than patients diagnosed in 1990s and 1980s (Figure). Hazard ratios (HR) for any CVD events demonstrated significant reduction in CVD events among patients with incident RA in 2000s compared with incident RA in 1980s (HR: 0.52; 95% confidence interval (CI): 0.32-0.86) and a reduction approaching significance compared with incident RA in 1990s (HR: 0.65; 95% CI: 0.40-1.05). Patients with incident RA in 2000s were compared with 405 patients without RA in 2000s who experienced 30 CVD events during follow-up. Patients with incident RA in 2000s had no excess in CVD events over subjects without RA (HR: 0.88, 95% CI: 0.53-1.46). Results were similar for MI, stroke and CHD deaths when examined separately. Conclusion Our findings show a dramatic reduction in incidence of major CVD events in RA in recent decades. The gap in CVD occurrence between RA patients and the general population may be closing. These findings may reflect increased awareness, improved primary CVD prevention and more optimal RA disease management in recent years. More studies are needed to understand the reasons and implications of these trends.

Association of Diet Quality With Risk of Incident Rheumatoid Arthritis in the Women’s Health Initiative

Long-term exposure to outdoor air pollution and the risk of development of rheumatoid arthritis: A systematic review and meta-analysis

BackgroundWe aimed to investigate the effects of ambient respiratory viral infections in the general population on rheumatoid arthritis (RA) development.MethodsData of weekly incident RA (2012–2013) were obtained from the Korean National Health Insurance claims database, and those of weekly observations on eight respiratory viral infections were obtained from the Korea Centers for Disease Control and Prevention database. We estimated the percentage change in incident RA associated with ambient mean respiratory viral infections using a generalized linear model, after adjusting for time trend, air pollution, and meteorological data.ResultsA total of 24,117 cases of incident RA (mean age 54.7 years, 18,688 [77.5%] women) were analyzed. Ambient respiratory viral infections in the population were associated with a higher number of incident RA over time, and its effect peaked 6 or 7 weeks after exposure. Among the 8 viruses, parainfluenza virus (4.8% for 1% respiratory viral infection increase, 95% CI 1.6 to 8.1, P = .003), coronavirus (9.2%, 3.9 to 14.8, P < .001), and metapneumovirus (44%, 2.0 to 103.4, P = .038) were associated with increased number of incident RA. The impact of these respiratory viral infections remained significant in women (3.8%, 12.1%, and 67.4%, respectively, P < .05) and in older patients (10.7%, 14.6%, and 118.2%, respectively, P < .05).ConclusionsAmbient respiratory viral infections in the population were associated with an increased number of incident RA, especially in women and older patients, suggesting that respiratory viral infections can be a novel environmental risk factor for the development of RA.

To examine trends in the incidence and prevalence of rheumatoid arthritis (RA) from 1995 to 2007. To augment our preexisting inception cohort of patients with RA (1955-1994), we assembled a population-based incidence cohort of individuals >or=18 years of age who first fulfilled the American College of Rheumatology 1987 criteria for the classification of RA between January 1, 1995 and December 31, 2007 and a cohort of patients with prevalent RA on January 1, 2005. Incidence and prevalence rates were estimated and were age-and sex-adjusted to the white population in the US in 2000. Trends in incidence rates were examined using Poisson regression methods. The 1995-2007 incidence cohort comprised 466 patients (mean age 55.6 years), 69% of whom were female and 66% of whom were rheumatoid factor positive. The overall age- and sex-adjusted annual RA incidence was 40.9/100,000 population. The age-adjusted incidence in women was 53.1/100,000 population (versus 27.7/100,000 population in men). During the period of time from 1995 to 2007, the incidence of RA increased moderately in women (P = 0.02) but not in men (P = 0.74). The increase was similar among all age groups. The overall age- and sex-adjusted prevalence on January 1, 2005 was 0.72% (95% confidence interval [95% CI] 0.66, 0.77), which is an increase when compared with a prevalence of 0.62% (95% CI 0.55, 0.69) in 1995 (P < 0.001). Applying the prevalence on January 1, 2005 to the US population in 2005 showed that an estimated 1.5 million US adults were affected by RA. This is an increase from the previously reported 1.3 million adults with RA in the US. The incidence of RA in women appears to have increased during the period of time from 1995 to 2007. The reasons for this recent increase are unknown, but environmental factors may play a role. A corresponding increase in the prevalence of RA was also observed.

POS0478 ASSOCIATION BETWEEN BODY SHAPES AND BODY SHAPE TRAJECTORIES, AND THE RISK OF RHEUMATOID ARTHRITIS IN THE FRENCH E3N COHORT

Exposure to passive smoking and rheumatoid arthritis risk: results from the Swedish EIRA study.

While some studies have suggested that moderate alcohol consumption may be beneficial for rheumatoid arthritis (RA) prevention(1), the role of competing events have not been considered and may lead to misinterpretation of the magnitude of the risk between alcohol intake and RA incidence. We aimed to investigate the relationship between alcohol consumption and RA incidence when the competing risk of death is accounted for in the survival analysis.Data from the UK Women’s Cohort Study (UKWCS), a prospective cohort study of 35,372 middleaged women established between 1995 and 1998, was used for the analyses(2). Alcohol intake was assessed at baseline by asking for the number of specified units of each type of alcoholic beverage (beer, wine, sherry, and spirits) consumed per week. Cases who developed RA were identified through linkage with Hospital Episode Statistics (HES) up to March 2019 (International Classification of Diseases, ICD-10 code M05-M06). Data linkage with the Health and Social Care Information Centre (HSCIC) allowed cause of death to be identified using ICD codes (9th/10th version). We used directed acyclic graphs, competing risk regression modelling, and subgroup analyses to examine the effect of alcohol intake on RA incidence.Among 29,830 women linked to the HES data (666,857 person-years), 255 cases of rheumatoid arthritis were identified, with a median follow-up of 22.5 years. After adjustment for confounders, in both competing risk regression and cox proportional hazards models, regular drinking was associated with a reduced risk of RA. In the competing risk model, with occasional drinkers (less than 1 serving of alcohol per week) as the reference, the subhazard ratios (SHRs) for non-drinkers were: SHR, 0.67, 95% CI: 0.43-1.07; regular drinkers: SHR, 0.70, 95% CI: 0.53−0.94. Every additional unit of alcohol per week was associated with a 3% lower risk of rheumatoid arthritis (SHR (95% CI): 0.97(0.96−0.99)). BMI modified the linear associations between alcohol intake and risk of RA(Pinteraction = 0.01). The incidence of RA in participants with a BMI &lt; 30 kg/m2 (227 cases, 27,015 participants) was 2% lower for each additional serving of alcohol consumed per week (0.98(0.96−0.99)),no statistically significant effect was seen for alcohol in those with a BMI 30+kg/m2, though numbers were smaller in this group.

Use of dipeptidyl peptidase-4 inhibitors is associated with a lower risk of rheumatoid arthritis in patients with type 2 diabetes mellitus: A systematic review and meta-analysis of cohort studies

In previous literature regarding development of rheumatoid arthritis (RA), female reproductive factors have been described as protective factors, risk factors, or irrelevant, leading to inconsistent results. The aim of this study was to investigate the effect of female reproductive factors on the incidence of seropositive RA. A large population-based retrospective cohort of the National Health Insurance Service data in South Korea was used. Postmenopausal women who participated in both cardiovascular and breast cancer screening in 2009 were included and followed until date of seropositive RA diagnosis, death, or December 31, 2018. Multivariable-adjusted Cox proportional hazards model was used to assess the association between reproductive factors and incident seropositive RA. Of 1,357,736 postmenopausal women, 6056 women were diagnosed with seropositive RA, and the incidence rate was 54.16 cases/100,000 person-years. Reproductive factors other than hormone replacement therapy (HRT) were not significantly associated with seropositive RA incidence. Postmenopausal women who used HRT ≥ 5 years were associated with a higher aHR of incident seropositive RA than never-users (aHR 1.25; 95% CI 1.09–1.44). Alcohol consumption less than 30 g per day (aHR 0.80; 95% CI 0.74–0.87), regular physical activity (aHR 0.90; 95% CI 0.84–0.97), diabetes mellitus (aHR 0.85; 95% CI 0.78–0.93), and cancer (aHR 0.77; 95% CI 0.64–0.92) were associated with lower risk of seropositive RA. Most female reproductive factors did not significantly affect the development of seropositive RA in postmenopausal women. Only HRT is associated with a small but significant increase in risk of seropositive RA.

Association of social isolation and loneliness with incident rheumatoid arthritis in a population-based cohort study.

BackgroundThe Mediterranean diet has been associated with lower mortality and lower risk of cardiovascular diseases and cancer. Although its components have been analysed in several studies, only one study has specifically investigated the association between Mediterranean diet and risk of rheumatoid arthritis (RA), and reported no association.MethodsData on 1721 patients with incident RA (cases) and 3667 controls, matched on age, gender and residential area, from the Swedish epidemiological investigation of RA (EIRA), a population-based case-control study, were analysed using conditional logistic regression. The Mediterranean diet score, ranging from 0 to 9, was calculated from a 124-item food frequency questionnaire.ResultsIn the EIRA study (median age of participants 53 years), 24.1% of the patients and 28.2% of the controls had high adherence to the Mediterranean diet (a score between 6 and 9). After adjustments for body mass index, educational level, physical activity, use of dietary supplements, energy intake, and smoking, high adherence reduced the odds of developing RA by 21% (OR 0.79; 95% CI 0.65–0.96) as compared to low adherence (a score between 0 and 2). The OR was even lower among men (OR 0.49; 95% CI 0.33–0.73), but no significant association was found among women (OR 0.94; 95% CI 0.74–1.18). An association between high diet score and low risk of RA was observed in rheumatoid factor (RF)-positive (OR 0.69; 95% CI 0.54–0.88), but not RF-negative RA (OR 0.96; 95% CI 0.68–1.34), and in RA characterised by presence of antibodies to citrullinated peptides (ACPA), but not in ACPA-negative RA.ConclusionsIn this large population-based case-control study, the Mediterranean diet score was inversely associated with risk of RA. However, an association was only found among men and only in seropositive RA.

Association between a history of periodontitis and the risk of rheumatoid arthritis: a nationwide, population-based, case–control study

The goal of this review paper is to summarize the main research and findings regarding air pollution and its association with the risk and progression of rheumatoid arthritis (RA). The most studied components of air pollution included particulate matter of ≤ 2.5 microns in diameter (PM2.5), PM10, carbon monoxide (CO), nitrogen dioxide (NO2), nitric oxide (NOx), sulfur dioxide (SO2), and ozone (O3). In addition, specific occupations and occupational inhalants have been investigated for RA risk. Several studies showed that increased exposure to air pollutants increased the risk of developing RA, particularly seropositive RA. There was evidence of gene-inhalant interactions for seropositive RA risk. Fewer studies have been conducted on RA disease activity and bone erosions. Some studies suggest that patients with RA-associated interstitial lung disease may have worse outcomes if exposed to air pollution. We summarized associations between air pollution and increased RA risk, including RA-associated interstitial lung disease. Relatively few studies investigated air pollution and RA disease activity or other outcomes. These results suggest an important role of air pollution for seropositive RA development and suggest that climate change could be a driver in increasing RA incidence as air pollution increases.