VA Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha.
VA Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha, and University of Nebraska at Lincoln, Lincoln.
Arthritis Rheumatol. 2021 Mar;73(3):392-400. doi: 10.1002/art.41559. Epub 2021 Jan 29.
To determine the association of inhalant exposures with rheumatoid arthritis (RA)-related autoantibodies and severity in US veterans.
Participants in the Veterans Affairs Rheumatoid Arthritis (VARA) registry were mailed surveys assessing occupational, agricultural, and military inhalant exposures. Demographic characteristics, disease activity, functional status, and extraarticular features were obtained from the VARA registry, while HLA-DRB1 shared epitope (SE) status, anti-cyclic citrullinated peptide (anti-CCP) antibodies, and rheumatoid factor (RF) were measured using banked DNA/serum from enrollment. Associations between inhalant exposures and RA-related factors (autoantibodies, severity, and extraarticular features) were assessed using multivariable linear and logistic regression models adjusted for age, sex, race, and tobacco use and stratified by SE status. Adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated.
Questionnaires were returned by 797 of 1,566 participants (50.9%). Survey respondents were older, more often White or male, and less frequently smokers, and had lower disease activity compared to nonrespondents. Anti-CCP positivity was more common among veterans exposed to burn pits (OR 1.66 [95% CI 1.02, 2.69]) and military waste disposal (OR 1.74 [95% CI 1.04, 2.93]) independent of other factors. Among participants who were positive for SE alleles, burn pit exposure (OR 5.69 [95% CI 2.73, 11.87]) and military waste disposal exposure (OR 5.05 [95% CI 2.42, 10.54]) were numerically more strongly associated with anti-CCP positivity. Several inhalant exposures were associated with the presence of chronic lung disease, but not with the presence of RF or the level of disease activity.
Military burn pit exposure and military waste disposal exposure were independently associated with the presence of anti-CCP antibodies in RA patients. These findings are consistent with emerging evidence that various inhalant exposures influence autoantibody expression and RA risk.
在美国退伍军人中，确定吸入暴露与类风湿关节炎（RA）相关自身抗体和严重程度的关联。
退伍军人事务部类风湿关节炎（VARA）登记处的参与者通过邮寄调查评估职业、农业和军事吸入暴露。从 VARA 登记处获得人口统计学特征、疾病活动、功能状态和关节外特征，同时使用银行存款的 DNA/血清从入组时测量 HLA-DRB1 共享表位（SE）状态、抗环瓜氨酸肽（抗 CCP）抗体和类风湿因子（RF）。使用多变量线性和逻辑回归模型评估吸入暴露与 RA 相关因素（自身抗体、严重程度和关节外特征）之间的关联，调整年龄、性别、种族和吸烟，并按 SE 状态分层。计算调整后的优势比（OR）和 95%置信区间（95%CI）。
在 1566 名参与者中的 797 名（50.9%）返回了问卷。与未回复者相比，调查受访者年龄较大，更多为白人或男性，较少为吸烟者，且疾病活动程度较低。接触焚烧坑（OR 1.66 [95%CI 1.02, 2.69]）和军事废物处理（OR 1.74 [95%CI 1.04, 2.93]）的退伍军人中抗 CCP 阳性更为常见，而其他因素则独立于其他因素。在 SE 等位基因阳性的参与者中，接触焚烧坑（OR 5.69 [95%CI 2.73, 11.87]）和接触军事废物处理（OR 5.05 [95%CI 2.42, 10.54]）与抗 CCP 阳性的关联更为强烈。一些吸入暴露与慢性肺病的存在有关，但与 RF 的存在或疾病活动水平无关。
军事焚烧坑暴露和军事废物处理暴露与 RA 患者抗 CCP 抗体的存在独立相关。这些发现与越来越多的证据一致，即各种吸入暴露会影响自身抗体的表达和 RA 的风险。
