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

Abstract

BackgroundIdentification 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).MethodsAn 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.ResultsTwo 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.ConclusionsA 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.

Predictors of Radiographic Erosion and Joint Space Narrowing Progression in Patients with Early Rheumatoid Arthritis: A Cohort Study

“…There are con icting data on the impact of patient age and sex [6], while for cigarette smoking and body constitution there is mounting evidence suggesting important associations with radiographic progression. In previously published data we have shown that smoking is associated with more radiographic progression and high body mass index (BMI) is associated with less radiographic progression in early RA [11]. Similar results have been presented by others [12][13][14][15][16].…”

Changes in bone mineral density over 10 years in patients with early rheumatoid arthritis

“…The patients were included before the current practice of treat to target was implemented,18 and before early treatment with biological disease modifying antirheumatic drugs (bDMARDs) came into widespread use. Results on other outcomes in this cohort have been reported previously 19 20…”

CD21−/low B cells associate with joint damage in rheumatoid arthritis patients

“…Previous studies have shown that smoking is associated with a more erosive disease in ACPA + patients . Amongst the small number of smokers available to us, there was no association between smoking and the CD21 −/low DN subset, indicating that the structural effect on bone that correlates with this subset was unlikely to be a result of smoking.…”