Long-Term Physical Activity and Subsequent Risk for Rheumatoid Arthritis Among Women: A Prospective Cohort Study
Long-Term Physical Activity and Subsequent Risk for Rheumatoid Arthritis Among Women: A Prospective Cohort Study
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DOI：
10.1002/art.40899
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发表时间：
2019-07-19
影响因子：
13.3
通讯作者：
Sparks, Jeffrey A.
中科院分区：
文献类型：
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作者：
Liu, Xinyi;Tedeschi, Sara K.;Sparks, Jeffrey A.
目的在前瞻性队列研究中评价长期体力活动对类风湿性关节炎(RA)发病风险的影响。方法对1989-2015年间《护士健康研究II》中的女性进行体力活动与类风湿性关节炎风险的调查。使用两年一次的调查问卷前瞻性地获得体力活动暴露和协变量。两位风湿病学家独立审查了在两年一次的问卷调查中自我报告新的RA诊断并根据补充调查筛查RA阳性的女性的医疗记录。所有类风湿性关节炎病例均符合1987年美国风湿病学会(ACR)或2010年美国风湿病学会/欧洲风湿病联盟(EULAR)对类风湿性关节炎的分类标准。初步分析调查了类风湿性关节炎诊断前2-8年的长期累计平均娱乐体力活动小时数，选择这一时间跨度是为了减少反向因果偏差的可能性，因为早期类风湿性关节炎在诊断前影响体力活动。使用95%可信区间(95%CI)的估计COX回归风险比(HR)来评估与体力活动类别相关的RA血清学表型(ALL、血清阳性或血清阴性)的风险。这些分析调整了18岁时的身体质量指数(BMI)和随时间变化的潜在混杂因素，并量化了更新的BMI在体力活动和RA风险之间相互作用的中介作用。结果在分析的113,366名妇女中，在2,428,573人年的随访中，发现了506例RA发病病例(67.0%的RA血清阳性)。在调整了包括吸烟、饮食质量和18岁时体重指数在内的混杂因素后，增加累计平均娱乐体育活动总时数与RA风险降低相关，如下：
Objective To evaluate the effects of long-term physical activity on subsequent risk of rheumatoid arthritis (RA) in a prospective cohort study. Methods This study investigated physical activity and RA risk among women from the Nurses' Health Study II (1989-2015). Physical activity exposures and covariates were prospectively obtained using biennial questionnaires. Two rheumatologists independently reviewed the medical records of women who self-reported a new diagnosis of RA on biennial questionnaires and who screened positive for RA based on a supplemental survey. All incident RA cases met the 1987 American College of Rheumatology (ACR) or 2010 ACR/European League Against Rheumatism (EULAR) classification criteria for RA. The primary analysis investigated the long-term cumulative average number of hours spent in recreational physical activity 2-8 years prior to the RA diagnosis, a time span chosen to reduce the potential for reverse causation bias, since early RA affects physical activity prior to diagnosis. Estimated Cox regression hazard ratios (HRs) with 95% confidence intervals (95% CIs) were used to assess the risk of RA serologic phenotypes (all, seropositive, or seronegative) in relation to physical activity categories. The analyses were adjusted for body mass index (BMI) at age 18 years and time-varying potential confounders, and the mediating effect of updated BMI on the interaction between physical activity and RA risk was quantified. Results Among the 113,366 women analyzed, 506 incident RA cases (67.0% with seropositive RA) were identified during 2,428,573 person-years of follow-up. After adjustment for confounders, including smoking, dietary quality, and BMI at age 18 years, increasing cumulative average total hours of recreational physical activity was associated with a reduced risk of RA, as follows: HR 1.00 for