Manfredsdottir V F, Vikingsdottir T, Jonsson T, Geirsson A J, Kjartansson O, Heimisdottir M, Sigurdardottir S L, Valdimarsson H, Vikingsson A
Department of Immunology, Landspitali University Hospital, 101 Reykjavik, Iceland.
Rheumatology (Oxford). 2006 Jun;45(6):734-40. doi: 10.1093/rheumatology/kei240. Epub 2006 Jan 10.
To study the effect of tobacco smoking and rheumatoid factor (RF) isotypes on disease activity and joint damage in early rheumatoid arthritis (RA).
One hundred early RA patients were followed prospectively for 2 yr. They were evaluated at recruitment and at 6 and 24 months. Sociodemographic information included smoking history, and radiographs of hands and feet were obtained. RF was monitored by IgM- and IgA-specific RF enzyme-linked immunosorbent assay and by agglutination, and serial measurements were also obtained for C-reactive protein. The influence of tobacco smoking and RF positivity on disease outcome was evaluated using multivariate analysis. Covariates for the regression analysis included sex, age, coffee consumption and IgA-RF positivity.
A gradient of increase in disease activity was observed from never smokers to former smokers to current smokers during the 2 yr of observation, defined by number of swollen joints (SJC), tender joints (TJC) and visual analogue scale for pain (P<0.001, P=0.02 and P=0.005, respectively), but smoking status did not influence radiological progression. Ever smokers were more often IgA RF positive (P<0.05). IgA RF-positive patients had more active disease (SJC P=0.002, TJC P=0.01) and showed more radiological progression (P<0.0001) compared with IgA RF-negative patients. Of the RF-positive patients 22% had elevated IgM RF without IgA RF and these patients showed similar disease activity and radiological joint progression to the RF-negative patients. None of these associations were explained by possible confounders.
Tobacco smoking has an adverse effect on patients with early RA and this is possibly immunologically mediated. IgM RF does not predict poorer prognosis in RA unless it is associated with a concomitant elevation of IgA RF.
研究吸烟及类风湿因子（RF）亚型对早期类风湿关节炎（RA）疾病活动度及关节损伤的影响。
对100例早期RA患者进行为期2年的前瞻性随访。在入组时以及6个月和24个月时对他们进行评估。社会人口统计学信息包括吸烟史，并获取手足的X线片。通过IgM和IgA特异性RF酶联免疫吸附测定及凝集试验监测RF，并对C反应蛋白进行系列测量。使用多变量分析评估吸烟和RF阳性对疾病结局的影响。回归分析的协变量包括性别、年龄、咖啡摄入量和IgA-RF阳性。
在2年的观察期内，从不吸烟者到既往吸烟者再到当前吸烟者，疾病活动度呈递增梯度，以肿胀关节数（SJC）、压痛关节数（TJC）和疼痛视觉模拟量表来定义（分别为P<0.001、P=0.02和P=0.005），但吸烟状态不影响放射学进展。曾经吸烟者更常出现IgA RF阳性（P<0.05）。与IgA RF阴性患者相比，IgA RF阳性患者疾病活动度更高（SJC P=0.002，TJC P=0.01），且放射学进展更明显（P<0.0001）。在RF阳性患者中，22%的患者IgM RF升高但无IgA RF，这些患者的疾病活动度和放射学关节进展与RF阴性患者相似。这些关联均未被可能的混杂因素所解释。
吸烟对早期RA患者有不良影响，这可能是由免疫介导的。IgM RF不能预测RA的预后较差，除非它与IgA RF同时升高。
