Salliot Carine, Nguyen Yann, Boutron-Ruault Marie-Christine, Seror Raphaèle
Centre for Research in Epidemiology and Population Health, (CESP), INSERM U1018, Université Paris-Sud, F-94800 Villejuif, France.
Rheumatology Department, Centre Hospitalier Régional d'Orléans, 45100 Orléans, France.
J Clin Med. 2020 Sep 26;9(10):3109. doi: 10.3390/jcm9103109.
Rheumatoid arthritis (RA) is a complex disease in which environmental agents are thought to interact with genetic factors that lead to triggering of autoimmunity.
We reviewed environmental, hormonal, and dietary factors that have been suggested to be associated with the risk of RA.
Smoking is the most robust factor associated with the risk of RA, with a clear gene-environment interaction. Among other inhalants, silica may increase the risk of RA in men. There is less evidence for pesticides, pollution, and other occupational inhalants. Regarding female hormonal exposures, there is some epidemiological evidence, although not consistent in the literature, to suggest a link between hormonal factors and the risk of RA. Regarding dietary factors, available evidence is conflicting. A high consumption of coffee seems to be associated with an increased risk of RA, whereas a moderate consumption of alcohol is inversely associated with the risk of RA, and there is less evidence regarding other food groups. Dietary pattern analyses (Mediterranean diet, the inflammatory potential of the diet, or diet quality) suggested a potential benefit of dietary modifications for individuals at high risk of RA.
To date, smoking and silica exposure have been reproducibly demonstrated to trigger the emergence of RA. However, many other environmental factors have been studied, mostly with a case-control design. Results were conflicting and studies rarely considered potential gene-environment interactions. There is a need for large scale prospective studies and studies in predisposed individuals to better understand and prevent the disease and its course.
类风湿性关节炎（RA）是一种复杂的疾病，环境因素被认为与导致自身免疫触发的遗传因素相互作用。
我们回顾了已被提出与RA风险相关的环境、激素和饮食因素。
吸烟是与RA风险相关的最显著因素，存在明确的基因-环境相互作用。在其他吸入物中，二氧化硅可能会增加男性患RA的风险。关于农药、污染和其他职业性吸入物的证据较少。关于女性激素暴露，有一些流行病学证据表明激素因素与RA风险之间存在联系，尽管文献报道并不一致。关于饮食因素，现有证据相互矛盾。大量饮用咖啡似乎与RA风险增加有关，而适量饮酒与RA风险呈负相关，关于其他食物组的证据较少。饮食模式分析（地中海饮食、饮食的炎症潜力或饮食质量）表明，饮食调整对RA高危个体可能有益。
迄今为止，吸烟和接触二氧化硅已被反复证明会引发RA的出现。然而，已经对许多其他环境因素进行了研究，大多采用病例对照设计。结果相互矛盾，且研究很少考虑潜在的基因-环境相互作用。需要进行大规模的前瞻性研究以及对易感个体进行研究，以更好地理解和预防该疾病及其病程。
