Smoking as a risk factor for the radiological severity of rheumatoid arthritis: a study on six cohorts
Smoking as a risk factor for the radiological severity of rheumatoid arthritis: a study on six cohorts
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DOI：
10.1136/annrheumdis-2013-203940
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发表时间：
2014-07-01
影响因子：
27.4
通讯作者：
van der Helm-van Mil, A. H. M.
中科院分区：
文献类型：
--
作者：
de Rooy, D. P. C.;van Nies, J. A. B.;van der Helm-van Mil, A. H. M.
背景吸烟是抗瓜氨酸蛋白抗体（ACPA）阳性类风湿关节炎（RA）发生的危险因素。吸烟是否易导致严重的关节损伤进展尚不清楚，因为有害的，保护性和中性observations have been made. Objective To determine the effect of smoking on joint damage progression.Methods吸烟状态进行了评估，在3158例RA患者包括在6个队列（莱顿早期关节炎诊所（Leiden-EAC），BARFOT，隆德，冰岛，NDB和威奇托）。共评估了9412张X线片。进行多元正态回归和线性回归分析。数据进行了总结，在一个随机效应逆方差meta analys.Results比较放射学进展的RA患者从来没有，过去和现在的吸烟者，吸烟与更严重的关节损伤莱顿EAC（p = 0.042）和BARFOT（p = 0.015）RA患者。在其他队列中未发现显著相关性，尽管对6个队列的荟萃分析显示吸烟者的关节损伤进展显著更严重（p = 0.01）。由于吸烟易患ACPA，因此使用ACPA作为额外的调整因素重复分析。然后失去了关联（荟萃分析p = 0.29）。结论多队列研究表明，吸烟对关节损伤的影响是通过ACPA介导的，吸烟不是RA放射学进展的独立危险因素。
Background Smoking is a risk factor for the development of anti -citrullinated protein antibodies (ACPA) positive rheumatoid arthritis (RA). Whether smoking predisposes to severe joint damage progression is not known, since deleterious, protective and neutral observations have been made.Objective To determine the effect of smoking on joint damage progression.Methods Smoking status was assessed in 3158 RA patients included in six cohorts (Leiden Early Arthritis Clinic (Leiden-EAC), BARFOT, Lund, Iceland, NDB and Wichita). In total 9412 radiographs were assessed. Multivariate normal regression and linear regression analyses were performed. Data were summarised in a random effects inverse variance meta-analysis.Results When comparing radiological progression for RA patients that were never, past and current smokers, smoking was significantly associated with more severe joint damage in Leiden-EAC (p=0.042) and BARFOT (p=0.015) RA patients. No significant associations were found in the other cohorts, though a meta-analysis on the six cohorts showed significantly more severe joint damage progression in smokers (p=0.01). Since smoking predisposes to ACPA, analyses were repeated with ACPA as additional adjustment factor. Then the association was lost (meta-analysis p=0.29).Conclusions This multi-cohort study indicated that the effect of smoking on joint damage is mediated via ACPA and that smoking is not an independent risk factor for radiological progression in RA.