Carlens C, Jacobsson L, Brandt L, Cnattingius S, Stephansson O, Askling J
Department of Medicine, Karolinska University Hospital and Institute, Stockholm, Sweden.
Ann Rheum Dis. 2009 Jul;68(7):1159-64. doi: 10.1136/ard.2008.089342. Epub 2008 Oct 28.
To investigate the importance of birth characteristics and early life infections on the risk of later rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA).
A nationwide register-based case-control study was performed based on prospectively recorded data on individuals born in 1973 or later. Using the Swedish inpatient register and the early arthritis register, cases with RA aged 16 years or above (n = 333) and JIA (n = 3334) were identified. From the Swedish medical birth register (MBR), four controls per case, matched by sex, year and delivery unit were randomly selected. Through linkage to the MBR and to the Swedish inpatient register information on maternal, pregnancy and birth characteristics and infections during the first year of life was identified. Univariate and multivariate odds ratios (OR) were calculated using conditional logistic regression.
Overall, infections during the first year of life were associated with increased risks for seronegative (OR 2.6, 95% CI 1.0 to 7.0) but not seropositive (OR 1.2) RA and for JIA (OR 1.9, 95% CI 1.7 to 2.1). Low birth weight (OR 0.7) and being small for gestational age (OR 0.5) were associated with reduced risks of RA of borderline statistical significance. Preterm birth (gestational age < or =258 days) was associated with a non-significantly decreased risk of RA (OR 0.6). Large for gestational age (OR 1.6) and having more than three older siblings (OR 1.4) were non-significantly associated with the risk of RA.
Infections during the first year of life, and possibly also factors related to fetal growth and timing of birth, may be important in the aetiologies of adult RA and JIA.
探讨出生特征和早期生活感染对后期类风湿关节炎（RA）和幼年特发性关节炎（JIA）风险的重要性。
基于1973年或以后出生个体的前瞻性记录数据进行了一项全国性基于登记处的病例对照研究。利用瑞典住院登记处和早期关节炎登记处，确定了16岁及以上的RA病例（n = 333）和JIA病例（n = 3334）。从瑞典医学出生登记处（MBR）中，按性别、年份和分娩单位为每个病例随机选取4名对照。通过与MBR以及瑞典住院登记处的关联，确定了有关母亲、妊娠和出生特征以及生命第一年感染的信息。使用条件逻辑回归计算单变量和多变量优势比（OR）。
总体而言，生命第一年的感染与血清阴性RA（OR 2.6，95% CI 1.0至7.0）而非血清阳性RA（OR 1.2）以及JIA（OR 1.9，95% CI 1.7至2.1）的风险增加相关。低出生体重（OR 0.7）和小于胎龄（OR 0.5）与RA风险降低相关，具有临界统计学意义。早产（胎龄≤258天）与RA风险非显著降低相关（OR 0.6）。大于胎龄（OR 1.6）和有三个以上哥哥姐姐（OR 1.4）与RA风险非显著相关。
生命第一年的感染，以及可能与胎儿生长和出生时间相关的因素，在成人RA和JIA的病因学中可能很重要。
