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Smoking, body mass index, disease activity, and the risk of rapid radiographic progression in patients with early rheumatoid arthritis

Rydell, Emil LU ; Forslind, Kristina LU ; Nilsson, Jan-Åke LU ; Jacobsson, Lennart T H LU and Turesson, Carl LU (2018) In Arthritis Research & Therapy 20(1).
Abstract

BACKGROUND: Identification of risk factors for rapid joint destruction in early rheumatoid arthritis (RA) can be helpful for optimizing treatment, and improving our understanding of destructive arthritis and its mechanisms. The objective of this study was to investigate the relationship between early RA patient characteristics and subsequent rapid radiographic progression (RRP).

METHODS: An inception cohort of patients with early RA (symptom duration < 12 months), recruited during 1995-2005 from a defined area (Malmö, Sweden), was investigated. Radiographs of the hands and feet were scored in chronological order according to the modified Sharp-van der Heijde score (SHS), by a trained reader. RRP was defined as an increase of ≥... (More)

BACKGROUND: Identification of risk factors for rapid joint destruction in early rheumatoid arthritis (RA) can be helpful for optimizing treatment, and improving our understanding of destructive arthritis and its mechanisms. The objective of this study was to investigate the relationship between early RA patient characteristics and subsequent rapid radiographic progression (RRP).

METHODS: An inception cohort of patients with early RA (symptom duration < 12 months), recruited during 1995-2005 from a defined area (Malmö, Sweden), was investigated. Radiographs of the hands and feet were scored in chronological order according to the modified Sharp-van der Heijde score (SHS), by a trained reader. RRP was defined as an increase of ≥ 5 points in SHS per year.

RESULTS: Two hundred and thirty-three patients were included. Radiographs were available from 216 patients at baseline, 206 patients at 1 year, and 171 patients at 5 years. Thirty-six patients (22%) had RRP up to 5 years. In logistic regression models, rheumatoid factor (RF) and anti-cyclic citrullinated peptides (anti-CCP), and increased erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) at baseline, predicted RRP over 5 years. Patients identified as overweight or obese had a significantly reduced risk of RRP up to 5 years (odds ratio (OR) 0.26; 95% confidence interval (CI) 0.11-0.63; adjusted for RF, baseline erosions, and ESR). Similar point estimates were obtained when stratifying for antibody status, and in models adjusted for smoking. A history of ever smoking was associated with a significantly increased risk of RRP up to 5 years, independent of body mass index (BMI) (OR 3.17; 95% CI 1.22-8.28; adjusted for BMI). At the 1-year follow-up, erosive changes, Disease Activity Score of 28 joints, Health Assessment Questionnaire, swollen joint count, and patient's global assessment of disease activity and pain were also significantly associated with RRP up to 5 years.

CONCLUSIONS: A history of smoking, presence of RF and/or anti-CCP and early erosions, high initial disease activity and active disease at 1 year, all increase the risk of RRP. Patients with a high BMI may have a reduced risk of severe joint damage. This pattern was not explained by differences in disease activity or antibody status. The results of this study suggest independent effects of smoking and BMI on the risk of RRP.

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organization
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Contribution to journal
publication status
published
subject
keywords
Journal Article
in
Arthritis Research & Therapy
volume
20
issue
1
publisher
BioMed Central
external identifiers
  • scopus:85046436708
ISSN
1478-6354
DOI
10.1186/s13075-018-1575-2
language
English
LU publication?
yes
id
3b33514d-8d44-42f9-9fe2-96099f33db8b
date added to LUP
2018-05-07 11:53:52
date last changed
2018-08-07 03:00:16
@article{3b33514d-8d44-42f9-9fe2-96099f33db8b,
  abstract     = {<p>BACKGROUND: Identification of risk factors for rapid joint destruction in early rheumatoid arthritis (RA) can be helpful for optimizing treatment, and improving our understanding of destructive arthritis and its mechanisms. The objective of this study was to investigate the relationship between early RA patient characteristics and subsequent rapid radiographic progression (RRP).</p><p>METHODS: An inception cohort of patients with early RA (symptom duration &lt; 12 months), recruited during 1995-2005 from a defined area (Malmö, Sweden), was investigated. Radiographs of the hands and feet were scored in chronological order according to the modified Sharp-van der Heijde score (SHS), by a trained reader. RRP was defined as an increase of ≥ 5 points in SHS per year.</p><p>RESULTS: Two hundred and thirty-three patients were included. Radiographs were available from 216 patients at baseline, 206 patients at 1 year, and 171 patients at 5 years. Thirty-six patients (22%) had RRP up to 5 years. In logistic regression models, rheumatoid factor (RF) and anti-cyclic citrullinated peptides (anti-CCP), and increased erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) at baseline, predicted RRP over 5 years. Patients identified as overweight or obese had a significantly reduced risk of RRP up to 5 years (odds ratio (OR) 0.26; 95% confidence interval (CI) 0.11-0.63; adjusted for RF, baseline erosions, and ESR). Similar point estimates were obtained when stratifying for antibody status, and in models adjusted for smoking. A history of ever smoking was associated with a significantly increased risk of RRP up to 5 years, independent of body mass index (BMI) (OR 3.17; 95% CI 1.22-8.28; adjusted for BMI). At the 1-year follow-up, erosive changes, Disease Activity Score of 28 joints, Health Assessment Questionnaire, swollen joint count, and patient's global assessment of disease activity and pain were also significantly associated with RRP up to 5 years.</p><p>CONCLUSIONS: A history of smoking, presence of RF and/or anti-CCP and early erosions, high initial disease activity and active disease at 1 year, all increase the risk of RRP. Patients with a high BMI may have a reduced risk of severe joint damage. This pattern was not explained by differences in disease activity or antibody status. The results of this study suggest independent effects of smoking and BMI on the risk of RRP.</p>},
  articleno    = {82},
  author       = {Rydell, Emil and Forslind, Kristina and Nilsson, Jan-Åke and Jacobsson, Lennart T H and Turesson, Carl},
  issn         = {1478-6354},
  keyword      = {Journal Article},
  language     = {eng},
  month        = {05},
  number       = {1},
  publisher    = {BioMed Central},
  series       = {Arthritis Research & Therapy},
  title        = {Smoking, body mass index, disease activity, and the risk of rapid radiographic progression in patients with early rheumatoid arthritis},
  url          = {http://dx.doi.org/10.1186/s13075-018-1575-2},
  volume       = {20},
  year         = {2018},
}