Kronzer Vanessa L, Yang Yangyuna, Roul Punyasha, Crooks James L, Crowson Cynthia S, Davis John M, Sparks Jeffrey A, Pierce Jeffrey R, O'Dell Katelyn, Sauer Brian C, Cannon Grant W, Baker Joshua F, Mikuls Ted R, England Bryant R
Mayo Clinic, Rochester, Minnesota.
VA Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha.
Arthritis Rheumatol. 2025 Jan 12. doi: 10.1002/art.43113.
The aim of this study was to determine whether pollutants such as fire smoke-related particulate matter <2.5 μm (PM) are associated with incident rheumatoid arthritis (RA) and RA-associated interstitial lung disease (RA-ILD).
This patient-control study used Veterans Affairs (VA) data from October 1, 2009, to December 31, 2018. We identified patients with incident RA and RA-ILD using validated algorithms, matching each patient to ≤10 controls on age, sex, and VA enrollment year. We obtained pollutants including fire smoke PM, carbon monoxide, nitrogen oxides (NOx), ozone, overall PM, PM, and sulfur dioxide (SO) at least one year before the index date. We fit conditional logistic regression models to estimate adjusted odds ratios (aORs) with 95% confidence intervals (CIs) for incident RA and RA-ILD, adjusted for confounders.
We identified 9,701 patients with incident RA (mean age 65 years, 86% male), including 531 patients with RA-ILD (mean age 69 years, 91% male), and 68,852 matched controls. Fire smoke PM was not associated with RA (aOR 1.07, 95% CI 0.92-1.23) but was associated with RA-ILD (aOR 1.98, 95% CI 1.08-3.62, per 1 μg/m). Increased levels of NOx were associated with RA (aOR 1.16, 95% CI 1.06-1.27, highest vs lowest quartile). The highest quartiles of ozone (aOR 1.19, 95% CI 1.06-1.34) and PM (aOR 1.25, 95% CI 1.10-1.43) were associated with seronegative RA. Carbon monoxide, overall PM, and SO were not, or negatively, associated with RA and RA-ILD.
Increased fire smoke PM was associated with RA-ILD, whereas NOx, ozone, and PM were associated with RA risk. Thus, air pollution may increase the risk of RA and RA-ILD.
本研究旨在确定诸如与火灾烟雾相关的细颗粒物（PM）等污染物是否与类风湿关节炎（RA）及RA相关间质性肺病（RA-ILD）的发病有关。
这项病例对照研究使用了2009年10月1日至2018年12月31日期间退伍军人事务部（VA）的数据。我们采用经过验证的算法识别出RA及RA-ILD患者，并根据年龄、性别和VA登记年份为每位患者匹配≤10名对照。我们获取了在索引日期前至少一年的污染物数据，包括火灾烟雾PM、一氧化碳、氮氧化物（NOx）、臭氧、总PM、PM和二氧化硫（SO）。我们拟合条件逻辑回归模型，以估计调整后的比值比（aOR）及95%置信区间（CI），用于分析RA及RA-ILD的发病情况，并对混杂因素进行了调整。
我们识别出9701例RA患者（平均年龄65岁，86%为男性），其中包括531例RA-ILD患者（平均年龄69岁，91%为男性），以及68852名匹配对照。火灾烟雾PM与RA无关（aOR 1.07，95%CI 0.92-1.23），但与RA-ILD有关（aOR 1.98，95%CI 1.08-3.62，每1μg/m）。NOx水平升高与RA有关（aOR 1.16，95%CI 1.06-1.27，最高四分位数与最低四分位数相比）。臭氧（aOR 1.19，95%CI 1.06-1.34）和PM（aOR 1.25，95%CI 1.10-1.43）的最高四分位数与血清阴性RA有关。一氧化碳、总PM和SO与RA及RA-ILD无关或呈负相关。
火灾烟雾PM增加与RA-ILD有关，而NOx、臭氧和PM与RA风险有关。因此，空气污染可能会增加RA及RA-ILD的风险。
