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)

作者：Lahiri Manjari; Luben Robert N; Morgan Catharine; Bunn Diane K; Marshall Tarnya; Lunt Mark; Verstappen Suzanne M M; Symmons Deborah P M; Khaw Kay Tee; Wareham Nick; Bruce Ian N^*

来源：Annals of the Rheumatic Diseases, 2014, 73(1): 219-226.

DOI：10.1136/annrheumdis-2012-202481

• Rheumatoid Arthritis
• Epidemiology
• Smoking

Objectives To investigate the association of lifestyle factors with risk of inflammatory polyarthritis (IP) and rheumatoid arthritis (RA).
Methods The European Prospective Investigation of Cancer, Norfolk, UK (EPIC-Norfolk) gathered lifestyle data from participants aged 40-79years 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.
Results 25455 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 52weeks 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.
Conclusions Several easily ascertained clinical and lifestyle factors can be used to stratify populations for risk of IP.

• 出版日期2014-1