Sánchez-Campamà Júlia, Nagra Navraj S, Pineda-Moncusí Marta, Prats-Uribe Albert, Prieto-Alhambra Daniel
Universitat Autònoma de Barcelona, Barcelona, Spain.
Centre for Statistics in Medicine, Botnar Research Centre, NDORMS, University of Oxford, UK.
Reumatol Clin (Engl Ed). 2020 Oct 12. doi: 10.1016/j.reuma.2020.08.006.
Smoking is one of the few modifiable risk factors associated with the development of rheumatoid arthritis (RA). Most published data are over 10 years old, and none included Mediterranean populations. We therefore took advantage of primary care routinely collected data to study the association between smoking and the development of RA in the general population of Catalonia, Spain.
We conducted a case-control study including all patients with a new diagnosis of RA registered in the SIDIAP database between 01/01/2008 and 31/12/2018; and matched them to up to 1:5 controls by age, gender and general practitioner. Smoking was classified by primary care staff into never, ex- or current smoking. Odds Ratios and 95% confidence intervals for the association between current and ex-smoking (compared to never smoking) and RA were estimated using conditional logistic regression adjusted for potential confounders.
A total of 13,920 RA cases and 69,535 controls were included. Compared with never smokers, current and ex-smokers were at increased risk of RA, with adjusted OR of 1.28 [95% CI 1.20-1.37] and OR 1.19 [1.12-1.26] respectively.
Our findings confirm an association between smoking and the risk of developing RA. The effect seems to prevail in the long-term and even in ex-smokers for 2 or more years after smoking cessation. More research is needed on the effects of smoking discontinuation on RA prevention and related outcomes.
吸烟是与类风湿性关节炎（RA）发病相关的少数可改变的风险因素之一。大多数已发表的数据已有10多年历史，且均未纳入地中海人群。因此，我们利用基层医疗常规收集的数据，研究吸烟与西班牙加泰罗尼亚普通人群中RA发病之间的关联。
我们进行了一项病例对照研究，纳入2008年1月1日至2018年12月31日期间在SIDIAP数据库中登记的所有新诊断为RA的患者；并按年龄、性别和全科医生将他们与最多1:5的对照进行匹配。基层医疗人员将吸烟情况分为从不吸烟、曾经吸烟或目前吸烟。使用针对潜在混杂因素进行调整的条件逻辑回归，估计目前吸烟和曾经吸烟（与从不吸烟相比）与RA之间关联的比值比和95%置信区间。
共纳入13920例RA病例和69535例对照。与从不吸烟者相比，目前吸烟者和曾经吸烟者患RA的风险增加，调整后的比值比分别为1.28 [95%置信区间1.20 - 1.37]和1.19 [1.12 - 1.26]。
我们的研究结果证实了吸烟与患RA风险之间的关联。这种影响似乎在长期内持续存在，甚至在戒烟2年或更长时间的曾经吸烟者中也是如此。需要更多关于戒烟对RA预防及相关结局影响的研究。
