Aho Kimmo, Heliövaara Markku
National Public Health Institute, Mannerheimintie 166, FIN-00300 Helsinki, Finland.
Ann Med. 2004;36(4):242-51. doi: 10.1080/07853890410026025.
Both genetic and environmental factors contribute to the development of rheumatoid arthritis (RA). A long-term latent process often precedes the onset of arthritis. Hence, the ultimate causes of RA cannot be clarified by studying only the inflamed joints. Longitudinal studies focusing on risk factors are crucial in approaching the true aetiology. At present, most information gained from epidemiological studies is contradictory or vague. For instance, there is no consensus concerning the long-term effects of pregnancy or the putative protective role of oral contraceptives. There is no doubt that diet plays a role, but no specific nutrient has proved to be either protective or deleterious. Smoking is the only environmental risk factor that has been firmly verified epidemiologically for RA. It can be reasonably regarded as a contributory cause of RA. Studying the immunological effects of exposure to cigarette smoke may offer an opportunity to combine information from basic and epidemiological research to clarify the causal chains leading to RA.
遗传因素和环境因素都对类风湿性关节炎（RA）的发病有影响。关节炎发作之前通常有一个长期的潜伏过程。因此，仅通过研究发炎的关节无法阐明RA的根本病因。关注风险因素的纵向研究对于探究真正的病因至关重要。目前，从流行病学研究中获得的大多数信息相互矛盾或模糊不清。例如，关于怀孕的长期影响或口服避孕药的假定保护作用尚无共识。毫无疑问，饮食起一定作用，但没有特定营养素被证明具有保护或有害作用。吸烟是唯一经流行病学确凿证实的RA环境风险因素。它可以合理地被视为RA的一个促成因素。研究接触香烟烟雾的免疫学效应可能提供一个机会，将基础研究和流行病学研究的信息结合起来，以阐明导致RA的因果链。
