Rhumatologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux universitaires Paris-Sud - Hôpital Bicêtre, Le Kremlin Bicêtre, Paris, France.
Center of Immunology of Viral Infections and Auto-immune Diseases (IMVA), Institut pour la Santé et la Recherche Médicale (INSERM) U1184, Université Paris-Sud, Université Paris-Saclay, Le Kremlin Bicêtre, Paris, France.
Rheumatology (Oxford). 2019 Jul 1;58(7):1154-1162. doi: 10.1093/rheumatology/key219.
To investigate the link between smoking status, including childhood and adult passive exposure, and the risk of incident RA.
The French E3N cohort includes 98 995 female volunteers prospectively followed since 1990. Self-administered questionnaires sent every 2-3 years collected medical events, general, lifestyle and environmental characteristics. RA diagnoses were collected in three successive questionnaires and confirmed if women received reimbursement for an RA-specific medication. The risk of incident RA was estimated using an age-adjusted Cox model that considers smoking status as a time-dependent variable.
Among 71 248 women, 371 incident RA cases were confirmed. Ever-smokers not exposed to passive smoking had an increased risk of RA [1.38 (95% CI 1.10, 1.74)]. In never-smokers, passive smoking exposure during childhood was associated with a borderline increased risk of RA in the same range as active smoking in adults, with an hazard ratio (HR) of 1.43 (95% CI 0.97, 2.11). Ever-smokers who also had childhood passive smoking exposure had a higher risk of RA than smokers not exposed during childhood [HR 1.67 (95% CI 1.17, 2.39)], but without a significant difference (P = 0.30). RA began earlier in smokers exposed to childhood passive smoking.
This study confirms that active smoking is associated with an increased risk of RA. It suggests for the first time that passive exposure to tobacco during childhood might also increase the risk of RA in future light smokers and probably non-smokers. Our results highlight the importance of avoiding any tobacco environment in children, especially in those with a family history of RA.
探讨吸烟状况（包括儿童期和成人期被动吸烟）与类风湿关节炎（RA）发病风险之间的关联。
法国 E3N 队列纳入了 98995 名女性志愿者，这些志愿者自 1990 年起进行前瞻性随访。通过自我报告的问卷，每 2-3 年收集一次医疗事件、一般、生活方式和环境特征等数据。RA 的诊断通过连续三份问卷收集，如果女性因 RA 专用药物获得报销，则可确诊。采用年龄调整的 Cox 模型估计发病风险，该模型将吸烟状况视为一个时变变量。
在 71248 名女性中，有 371 例确诊为 RA。从不吸烟且未暴露于被动吸烟的女性患 RA 的风险增加（HR 1.38，95%CI 1.10-1.74）。在从不吸烟的女性中，儿童期暴露于被动吸烟与成人期主动吸烟所致 RA 发病风险呈边缘性增加，风险比（HR）为 1.43（95%CI 0.97-2.11）。既吸烟又有儿童期被动吸烟暴露史的女性患 RA 的风险高于无儿童期被动吸烟暴露史的吸烟者（HR 1.67，95%CI 1.17-2.39），但差异无统计学意义（P = 0.30）。暴露于儿童期被动吸烟的吸烟者发病更早。
本研究证实主动吸烟与 RA 发病风险增加相关，首次提示儿童期被动暴露于烟草也可能增加未来轻度吸烟者甚至非吸烟者患 RA 的风险。我们的研究结果强调了在儿童时期避免任何烟草环境的重要性，尤其是在有 RA 家族史的儿童中。
