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. 2012 Mar;51(3):499-512.
doi: 10.1093/rheumatology/ker299. Epub 2011 Nov 24.

Modifiable risk factors for RA: prevention, better than cure?

Manjari Lahiri  1 , Catharine Morgan, Deborah P M Symmons, Ian N Bruce
Affiliations

Modifiable risk factors for RA: prevention, better than cure?

Manjari Lahiri et al. Rheumatology (Oxford). 2012 Mar.

Abstract

Objective: To perform a meta-synthesis of the evidence for modifiable lifestyle risk factors for inflammatory polyarthritis (IP) and RA.

Methods: We performed a MEDLINE literature search. Case-control and cohort studies and systematic reviews published from 1948 through February 2011 and studying modifiable risk factors for RA were retrieved. The main outcome measure was diagnosis of RA according to the standard criteria.

Results: Smoking contributes up to 25% of the population burden of RA. The risk is dose related, stronger in males and especially strong for anti-citrullinated peptide antibody positive (ACPA(+)) RA through an interaction with the shared epitope. After smoking cessation, there is, however, a latency of up to 20 years to return to baseline risk. Other associations are less definitive; however, prospective studies suggest that dietary antioxidants and breastfeeding may be protective and that high coffee consumption may increase RA risk. An inverse association with alcohol intake (especially in smokers) and with education/social class (especially seropositive RA) and an increased risk with obesity (seronegative RA) is also noted.

Conclusion: There is a need for further large-scale prospective studies with a consistent definition of RA phenotype (undifferentiated IP through to ACPA(+)/RF(+) disease). This will ultimately afford the opportunity to evaluate preventative population strategies for RA akin to the well-established programmes for cardiovascular disease and cancer, targeting common risk factors.

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Figures

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Fig. 1
Search terms and strategy.
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Fig. 2
Algorithm for selection of articles for review.
See this image and copyright information in PMC

References

    1. Tobon GJ, Youinou P, Saraux A. The environment, geo-epidemiology, and autoimmune disease: rheumatoid arthritis. Autoimmunity Rev. 2010;9:A288–92. - PubMed
    1. Liao KP, Alfredsson L, Karlson EW. Environmental influences on risk for rheumatoid arthritis. Curr Opin Rheumatol. 2009;21:279–83. - PMC - PubMed
    1. Aletaha D, Neogi T, Silman AJ, et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum. 2010;62:2569–81. - PubMed
    1. Arnett FC, Edworthy SM, Bloch DA, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988;31:315–24. - PubMed
    1. Symmons DP, Silman AJ. The Norfolk Arthritis Register (NOAR) Clin Exp Rheumatol. 2003;21:S94–9. - PubMed

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