Rheumatoid Arthritis Risk Report: 5 Pluses and Minuses

Aug 22, 2017

Recent research findings describe both positive and negative effects of RA-associated factors.

Rheumatoid arthritis risk goes up in certain occupations but goes down with oral contraceptive use. A positive RA test result is a risk factor for cardiovascular morbidity. Medication adherence lowers disease activity in patients with RA. Clinical outcomes may not be better in biologic dosing outliers.[[{"type":"media","view_mode":"media_crop","fid":"28604","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_5748437526734","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"7971","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 201px; width: 208px; border-width: 0px; border-style: solid; margin: 5px; float: right;","title":" ","typeof":"foaf:Image"}}]]

These recent research findings report on risk factors associated with rheumatoid arthritis and both their positive and negative effects.

Read on for brief summaries of the latest risk-related rheumatoid arthritis studies.

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Occupational Hazards: Certain Jobs Promote Rheumatoid Arthritis Risk[[{"type":"media","view_mode":"media_crop","fid":"28604","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_2080755518425","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"7971","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 188px; width: 205px; border-width: 0px; border-style: solid; margin: 5px; float: right;","title":" ","typeof":"foaf:Image"}}]]

To explore the association between occupation and the risk of anticitrullinated protein antibody (ACPA) + rheumatoid arthritis or ACPA- RA, researchers analyzed 3522 cases and 5580 controls from the Swedish population-based Epidemiological Investigation of RA case-control study.

Several occupations were found to be associated with ACPA+ RA or ACPA- RA, mainly those that involved potential noxious airborne agents.

Among men, the risk of ACPA+ RA was increased in bricklayers and concrete workers, material handling operators, and electrical and electronics workers. For ACPA- RA, risk was greater in bricklayers and concrete workers and in electrical and electronics workers.

Among women, risk was moderately increased in assistant nurses and attendants. No occupations were significantly associated with ACPA- RA among women.

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Rheumatoid Arthritis Risk Reduced by the Pill, But Not by Breastfeeding[[{"type":"media","view_mode":"media_crop","fid":"28604","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_4604391750549","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"7971","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 179px; width: 203px; border-width: 0px; border-style: solid; margin: 5px; float: right;","title":" ","typeof":"foaf:Image"}}]]

Researchers wanted to determine whether oral contraceptive use or breastfeeding influences rheumatoid arthritis risk and whether these factors interact with known risk factors in the development of ACPA+ RA. They adjusted for age, residential area, smoking, and alcohol consumption.

Oral contraceptive use decreased the risk of rheumatoid arthritis, especially ACPA+ RA, where an interaction with smoking was observed.

No significant associations were found for ACPA- RA.

Long duration of oral contraceptive use (> 7 years vs never use) decreased the risk of both ACPA+ RA and ACPA- RA.

• A significant interaction was observed between the lack of oral contraceptive use and smoking on the risk of ACPA+ RA. No interactions were found for breastfeeding.

An association between breastfeeding and a decreased risk of ACPA+ RA or ACPA- RA could not be confirmed.

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Positive RA Test Result Is Risk Factor for Cardiovascular Morbidity[[{"type":"media","view_mode":"media_crop","fid":"28604","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_7641068189847","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"7971","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 181px; width: 203px; border-width: 0px; border-style: solid; margin: 5px; float: right;","title":" ","typeof":"foaf:Image"}}]]

To determine whether positive anticyclic citrullinated peptide antibodies (anti-CCP) and rheumatoid factor (RF) test results are risk factors for 10-year cardiovascular disease (CVD) in patients with rheumatoid arthritis, researchers performed analyses using data from the Nijmegen early RA inception cohort.

Anti-CCP and RF were determined at baseline. Outcome was the first CVD event (ischemic heart disease, nonhemorrhagic cerebrovascular accident, or peripheral artery disease) after baseline as retrieved from physician diagnosis.

The presence of RF, but not anti-CCP, was associated with CVD in this cohort of patients with rheumatoid arthritis.

The HRadjusted for anti-CCP and for RF was 1.17 and 1.52, respectively.

The association of RF positivity with CVD was even stronger in the anti-CCP–negative patients (HRadjusted 2.09).

There was no significant interaction between anti-CCP and RF.

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Medication Adherence Lowers Disease Activity in Patients With Rheumatoid Arthritis[[{"type":"media","view_mode":"media_crop","fid":"28604","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_5420670949556","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"7971","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 181px; width: 193px; border-width: 0px; border-style: solid; margin: 5px; float: right;","title":" ","typeof":"foaf:Image"}}]]

Researchers performed a systematic search in major electronic databases to explore the impact of medication adherence on disease activity in patients with rheumatoid arthritis.

Patients with rheumatoid arthritis who have higher medication adherence tended to have lower disease activity.

The total score of the 28-joint count disease activity score was significantly lower in adherent patients than in nonadherent patients.

A significant difference in erythrocyte sedimentation rate and tender joint count was observed between medication adherent and nonadherent groups.

The meta-analysis results showed no significant difference between medication adherent and nonadherent patients in swollen joint count, visual analog scale, and C-reactive protein level.

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Biologic Dosing Outliers and Nonoutliers Have Similar Outcomes[[{"type":"media","view_mode":"media_crop","fid":"28604","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_5038286063748","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"7971","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 181px; width: 200px; border-width: 0px; border-style: solid; margin: 5px; float: right;","title":" ","typeof":"foaf:Image"}}]]

Because dosing of biologic medications for rheumatoid arthritis may vary among real-world patients, investigators conducted a retrospective, longitudinal cohort study to determine the patterns of care for biologic-dosing outliers and nonoutliers in biologic-naive patients.

Patients were newly initiated on adalimumab, etanercept, or infliximab as index biologic therapy. Outlier status was defined as having received at least 1 dose < 90% or > 110% of the approved dose in the package insert at any time during the study period.

About 1 in 10 study patients with rheumatoid arthritis was identified as a biologic-dosing outlier.

Patients who received etanercept were least likely to become outliers; those who received adalimumab were most likely.

During the 1-year follow-up, patients were more likely to be a high-dose outlier than a low-dose outlier (55% vs 45%).

Charlson Comorbidity Index score, etanercept and infliximab index biologic, and treatment with a nonbiologic disease-modifying antirheumatic drug (DMARD) before biologic initiation were associated with becoming high- or low-dose outliers.

Dosing outliers did not appear to have better clinical outcomes than nonoutliers.

The authors suggested that health care providers may better serve their patients with rheumatoid arthritis by prescribing alternate DMARD therapy before initiating outlier biologic dosing.

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