Using lifestyle factors to identify individuals at higher risk of inflammatory polyarthritis (results from the European Prospective Investigation of Cancer-Norfolk and the Norfolk Arthritis Register—the EPIC-2-NOAR Study)

Abstract

ObjectivesTo investigate the association of lifestyle factors with risk of inflammatory polyarthritis (IP) and rheumatoid arthritis (RA).MethodsThe European Prospective Investigation of Cancer, Norfolk, UK (EPIC-Norfolk) gathered lifestyle data from participants aged 40–79 years from 1993 to 1997. Individuals who subsequently developed IP were identified by linkage with the Norfolk Arthritis Register. A Cox proportional hazard model was developed, and a score assigned to each risk factor to calculate the odds of developing IP.Results25 455 EPIC participants were followed for a median (IQR) of 14.2 (12.9, 15.3) years; 184 developed incident IP (138 cumulatively fulfilled criteria for RA; 107 were seropositive). Pack-years of smoking were associated with increased risk of IP and RA in men (HR 1.21 (95% CI 1.08 to 1.37) per 10-pack-years) and seropositive IP (HR 1.24 (95% CI 1.10 to 1.41)) for all. Diabetes mellitus was associated with increased risk of IP (HR 2.54 (95% CI 1.26 to 5.09)), while alcohol (HR 0.86 (95% CI 0.74 to 0.99) per unit/day) and higher social class (HR 0.36 (95% CI 0.15 to 0.89) for professionals vs manual workers) were associated with reduced risk. Body mass index was associated with seronegative IP (HR 2.75 (95% CI 1.39 to 5.46) for obese vs normal-weight participants). In women, parity (HR 2.81 (95% CI 1.37 to 5.76) for ≥2 vs no children) was associated with increased risk, and breast feeding (HR 0.66 (95% CI 0.46 to 0.94) for every 52 weeks of breast feeding) was inversely associated with risk. Risk factors from the model were used to generate a ‘risk score’. A total of 1159 (8.4%) women had scores reflecting a >3-fold increased risk of IP over those with a score of 0.ConclusionsSeveral easily ascertained clinical and lifestyle factors can be used to stratify populations for risk of IP.

Clinical and lifestyle-related risk factors for incident multimorbidity: 10-year follow-up of Finnish population-based cohorts 1982–2012

“…Based on earlier research related to chronic diseases included in this study, serum cholesterol is associated strongly only with CVD whereas smoking as well as obesity are known risk factors for most of the chronic conditions included in analyses [18][19][20][21][22][30][31][32] explaining also the weak predictive effect seen for serum cholesterol in this study. In additions, after our 10-year follow-up the oldest participants were only 74 years old, which nowadays is a relatively low age for CVD event especially among women in Finland [33].…”

Prevalence of obesity in rheumatoid arthritis and its association with disease activity and latex positivity in a sample of patients in Erbil

“…Two case-control studies including 515 recent RA with 769 controls and 2748 RA with 3444 controls discovered a positive association between obesity and likelihood of developing RA negative for ACCP, with an increased risk of 3.45 (1.73 to 6.87) in the first study and 1.6 (1.2 to 2.2) in women in the second study. 33,38,39 Similarly, in two cohort studies performed by Lahiri et al and Lu et al large number of patients with RA were studied and monitored for a long term, they found that obesity is linked to high incidence of seronegative inflammatory polyarthritis (HR 2.75; 95% CI 1.39 to 5.46) 40 and seronegative RA (HR 1.34; 95% CI 1.03 to 1.74) 41,33 respectively. Furthermore, in the Lu et al study, the risk for patients with obesity who develop RA with onset before 55 years was much more increased in all patients with RA (seropositive and seronegative) (HR 1.65; 95% CI 1.34 to 2.05).…”

Atherosclerosis in rheumatoid arthritis: is it all about inflammation?

“…45 A 2014 prospective population study also demonstrated that both diabetes mellitus and obesity were risk factors for the development of inflam matory polyarthritis. 46 All three conditions (diabetes mel litus, obesity and RA) are known to be associated with chronic inflammation and increased levels of circulating adipokines, which might influence the initiation and course of both CVD and RA.…”