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Logo of arthrestherBioMed Centralbiomed central web sitesearchsubmit a manuscriptregisterthis articleArthritis Research & Therapy
 
Arthritis Res Ther. 2006; 8(4): R133.
Published online 2006 July 27. doi:  10.1186/ar2022
PMCID: PMC1779386
Environmental risk factors differ between rheumatoid arthritis with and without auto-antibodies against cyclic citrullinated peptides
Merete Pedersen,corresponding author1 Søren Jacobsen,2 Mette Klarlund,2 Bo V Pedersen,1 Allan Wiik,3 Jan Wohlfahrt,1 and Morten Frisch1
1Department of Epidemiology Research, Danish Epidemiology Science Centre, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark
2Department of Rheumatology, University Hospital of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark
3Department of Autoimmunology, Statens Serum Institut, Artillerivej 5, DK-2300, Copenhagen S, Denmark
corresponding authorCorresponding author.
Merete Pedersen: mtb/at/ssi.dk; Søren Jacobsen: sj/at/dadlnet.dk; Mette Klarlund: klarlund/at/dadlnet.dk; Bo V Pedersen: bvp/at/ssi.dk; Allan Wiik: aw/at/ssi.dk; Jan Wohlfahrt: jaw/at/ssi.dk; Morten Frisch: mfr/at/ssi.dk
Received March 4, 2006; Revisions requested April 20, 2006; Revised July 11, 2006; Accepted July 27, 2006.
Abstract
The aim of this study was to evaluate new and previously hypothesised non-genetic risk factors for serologic subtypes of rheumatoid arthritis (RA) defined by the presence or absence of auto-antibodies to cyclic citrullinated peptides (CCP). In a national case-control study, we included 515 patients recently diagnosed with RA according to the American College of Rheumatology 1987 classification criteria and 769 gender- and age-matched population controls. Telephone interviews provided information about non-genetic exposures, and serum samples for patients were tested for anti-CCP-antibodies. Associations between exposure variables and risk of anti-CCP-positive and anti-CCP-negative RA were evaluated using logistic regression. A series of RA subtype-specific risk factors were identified. Tobacco smoking (odds ratio [OR] = 1.65; 95% confidence interval: 1.03–2.64, for >20 versus 0 pack-years) was selectively associated with risk of anti-CCP-positive RA, whereas alcohol consumption exhibited an inverse dose-response association with this RA subtype (OR = 1.98, 1.22–3.19, for 0 versus >0–5 drinks per week). Furthermore, coffee consumption (OR = 2.18; 1.07–4.42, for >10 versus 0 cups per day), ever use of oral contraceptives (OR = 1.65; 1.06–2.57) and having a first-degree relative with schizophrenia (OR = 4.18; 1.54–11.3) appeared more strongly associated with risk of anti-CCP-positive RA. Obesity was selectively associated with risk of anti-CCP-negative RA, with obese individuals being at more than 3-fold increased risk of this subtype compared with normal-weight individuals (OR = 3.45; 1.73–6.87). Age at menarche was the only examined factor that was significantly associated with both serologic subtypes of RA (p-trends = 0.01); women with menarche at age ≥ 15 years had about twice the risk of either RA subtype compared with women with menarche at age ≤ 12 years. Major differences in risk factor profiles suggest distinct etiologies for anti-CCP-positive and anti-CCP-negative RA.
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