Zeng Pingling, Klareskog Lars, Alfredsson Lars, Bengtsson Camilla
Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden; Rheumatology Unit, Department of Medicine at Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden.
Rheumatology Unit, Department of Medicine at Karolinska University Hospital , Karolinska Institute , Stockholm , Sweden.
RMD Open. 2017 Mar 14;3(1):e000324. doi: 10.1136/rmdopen-2016-000324. eCollection 2017.
This study investigated: (1) the association of physical workload (PW) and risk of rheumatoid arthritis (RA); (2) the potential interactions between PW and the genes in the human leucocyte antigen (HLA) region.
A population-based case-control study involving incident cases of RA (3150 cases and 5130 controls) was performed using data from the Swedish Epidemiological Investigation of Rheumatoid Arthritis. Information on 7 types of self-reported PW exposure and genotypes of cases and controls were gathered. Anticitrullinated protein antibody (ACPA) status of cases was identified. For each PW exposures, exposed participants were compared with unexposed participants. ORs with 95% CIs of RA (overall), ACPA-positive RA and ACPA-negative RA associated with different PWs were estimated using logistic regression. HLA-PW interactions were estimated using the principle of departure from additivity of effects by calculating attributable proportion (AP) due to interaction.
ORs of developing RA associated with 6 various PW exposures ranging from 1.3 (95% CI 1.1 to 1.4) to 1.8 (95% CI 1.6 to 2.0) were observed. Exposure to more types of PW was associated with increasing risk for RA (p<0.0001). No major difference in the ORs between ACPA-positive and ACPA-negative RA was found. For some exposures, we found evidence of interactions between PW and the shared epitope genes, regarding risk of ACPA-positive RA (AP: from 0.3 (95% CI 0.1 to 0.5) to 0.4 (95% CI 0.2 to 0.6)).
PW is associated with the risk of ACPA-positive and ACPA-negative RA. Interactions between PW and the shared epitope were found in ACPA-positive RA.
本研究调查了：（1）体力负荷（PW）与类风湿关节炎（RA）风险之间的关联；（2）PW与人类白细胞抗原（HLA）区域基因之间的潜在相互作用。
利用瑞典类风湿关节炎流行病学调查的数据，开展了一项基于人群的病例对照研究，纳入RA新发病例（3150例病例和5130例对照）。收集了7种自我报告的PW暴露信息以及病例和对照的基因型。确定病例的抗瓜氨酸化蛋白抗体（ACPA）状态。对于每种PW暴露，将暴露参与者与未暴露参与者进行比较。使用逻辑回归估计与不同PW相关的RA（总体）、ACPA阳性RA和ACPA阴性RA的OR及95%CI。通过计算相互作用引起的归因比例（AP），利用效应相加性偏离原则估计HLA-PW相互作用。
观察到与6种不同PW暴露相关的发生RA的OR值在1.3（95%CI 1.1至1.4）至1.8（95%CI 1.6至2.0）之间。暴露于更多类型的PW与RA风险增加相关（p<0.0001）。在ACPA阳性和ACPA阴性RA的OR值之间未发现重大差异。对于某些暴露，我们发现了PW与共享表位基因之间关于ACPA阳性RA风险的相互作用证据（AP：从0.3（95%CI 0.1至0.5）至0.4（95%CI 0.2至0.6））。
PW与ACPA阳性和ACPA阴性RA的风险相关。在ACPA阳性RA中发现了PW与共享表位之间的相互作用。
