Saag K G, Cerhan J R, Kolluri S, Ohashi K, Hunninghake G W, Schwartz D A
Division of Rheumatology, University of Iowa College of Medicine, Iowa City 52242-1087, USA.
Ann Rheum Dis. 1997 Aug;56(8):463-9. doi: 10.1136/ard.56.8.463.
Cigarette smoking may influence rheumatoid arthritis (RA) disease incidence and may have direct biological effects on the lungs and systemically. This study sought to determine if cigarette smoking is associated with RA disease severity.
Clinical evaluations of patients seen in the University of Iowa rheumatology and orthopaedic ambulatory clinics were conducted. A letter of interest was mailed to 1701 patients who were first assigned an ICD-9-CM diagnostic code for RA in one of these clinics. A total of 857 patients expressed interest and were offered a clinical examination and 395 were evaluated over an 18 month period. Of these, 336 satisfied examiner criteria for prevalent RA and were included in the analysis. The disease characteristics and arthritis care utilisation of these patients seemed representative of prevalent cases in the general community. RA disease severity was assessed by radiographic bone erosions (graded as either present/ absent and using the Larsen system), rheumatoid factor seropositivity, and presence of subcutaneous rheumatoid nodules.
Pack years of cigarette smoking was significantly associated with rheumatoid factor seropositivity (p = 0.0001), radiographic erosions (p = 0.024), and nodules (p = 0.051). After adjustment for potential confounders, smokers with > or = 25 pack years were 3.1 times more likely to be rheumatoid factor positive (95% CI 1.7, 5.6) and 2.4 times more likely to show radiographic erosions (95% CI 1.2, 4.5) than never smokers. Less severe radiographic disease seemed to be more strongly associated with cigarette smoking than more severe disease.
Cigarette smoking may adversely influence the severity of RA in a potentially dose dependent fashion.
吸烟可能影响类风湿关节炎（RA）的发病率，并且可能对肺部及全身产生直接生物学效应。本研究旨在确定吸烟是否与RA疾病严重程度相关。
对在爱荷华大学风湿病学和骨科门诊就诊的患者进行临床评估。向1701名在这些门诊之一首次被分配RA的ICD - 9 - CM诊断代码的患者邮寄了一份意向函。共有857名患者表示感兴趣并接受了临床检查，在18个月期间对395名患者进行了评估。其中，336名患者符合检查者对现患RA的标准并纳入分析。这些患者的疾病特征和关节炎护理利用情况似乎代表了普通社区中的现患病例。通过放射学骨侵蚀（根据Larsen系统分级为存在/不存在）、类风湿因子血清阳性以及皮下类风湿结节的存在来评估RA疾病严重程度。
吸烟包年数与类风湿因子血清阳性（p = 0.0001）、放射学侵蚀（p = 0.024）和结节（p = 0.05）显著相关。在对潜在混杂因素进行调整后，吸烟≥25包年的吸烟者类风湿因子阳性的可能性是从不吸烟者的3.1倍（95%可信区间1.7, 5.6），出现放射学侵蚀的可能性是从不吸烟者的2.4倍（95%可信区间1.2, 4.5）。与更严重的疾病相比，不太严重的放射学疾病似乎与吸烟的关联更强。
吸烟可能以潜在的剂量依赖方式对RA的严重程度产生不利影响。
