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Allan Gelber, M.D.
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Abstract 597: Secondhand Smoke Exposure and the Risk of Rheumatoid Arthritis: Data from The Nurses health Study Background: Whereas cigarette smoking has been previously linked to an elevated risk of developing rheumatoid arthritis (RA), the relationship of secondhand exposure to cigarette smoking has not been well defined. Methods: Using data from the Nurses Health Study, the investigators examined this question. Among the 121,700 women in this longitudinal cohort study, information on secondhand smoke exposure was collected in 1982, when the participants were 36-61 years of age. 494 women developed confirmed RA, in the years 1982-2002. Secondhand exposure was assessed during childhood as one or both parents having smoked, and during adult live, if one lived with a smoker. Exposure to smoke at work was also ascertained. The participants' own smoking status was also collected. Results: The investigators found that women exposed to secondhand smoke for 30-39 years had a 40% increased risk (relative risk 1.4; 95% confidence interval 1.0-2.0) of developing rheumatoid arthritis. The relationship was stronger, and statistically significant, for women with > 40 years of smoking exposure (RR 1.7; 95% CI 1.4-2.2). Not surprisingly, current smoking status, and past smoking behavior were also related to an increased risk of developing rheumatoid arthritis. In multivariate analysis that simultaneously examined the relationship of secondhand exposure to smoking, and of the participants' own smoking behavior, the risk associated with secondhand smoking was substantially reduced. Editorial Comment: Thus, the observed relationship of secondhand exposure to an increase in risk of incident rheumatoid arthritis appeared to be mediated by the participants' own smoking status, rather than due to a direct harmful effect from secondhand exposure. | ||
Abstract 1222: Dietary Vitamin D Intake and Risk of Rheumatoid Arthritis Background: There is substantial interest among the lay community regarding the relationship of diet, and of vitamin consumption, to the risk of developing arthritis. Specifically, with regard to the putative link of vitamin D and the risk of developing rheumatoid arthritis, relatively little information is known. Methods: The investigators examined this relationship among the 121,700 female nurses who comprise the Nurses Health Study. Among the cohort, 90,980 women completed a food frequency questionnaire every four years, from 1980-2002. Of note, 436 participants developed new rheumatoid arthritis, confirmed by medical record review for conformance to ACR criteria. The protocol enabled assessment of vitamin D supplements consumed, as well as of food groups consumed that are rich in vitamin D; the latter included total dairy products as well as skim milk, whole milk, margarine and dark fish. Results: In the analyses, consumption of total dairy products was associated with a mild, reduced risk of developing RA (Relative Risk 0.80; 95% CI 0.57 - 1.11). This potential protective effect, however, was not statistically significant. In contrast, no relationship was observed between total vitamin D consumed, derived from diet and from supplements. Editorial Comment: These findings do not support a role for advocacy of vitamin D consumption to reduce one's risk of developing rheumatoid arthritis. | ||
Abstract 619: Ethnic Disparities in Health Status in Rheumatoid Arthritis Patients Methods: The investigators evaluated the relationship of ethnicity to clinical parameters and health outcomes among 5685 patients with rheumatoid arthritis in the Arthritis, Rheumatism, and Aging Medical Information System (ARAMIS) database. Levels of function, pain, and of patient global health status were ascertained. These parameters were then compared among the African American, Hispanic and Caucasian participants in the study. Results: The analyses demonstrated that the Caucasian patients with rheumatoid arthritis had the best scores among all 3 ethnic/racial groups, in terms of functional level, pain level and global health status assessment. Hispanics reported the worst scores among the three ethnic/racial groups, for each of the three parameters. Of note, the Caucasian patients were better educated and were on average of older age. Editorial Comment: Though this study does reveal differences in health status among the three groups with rheumatoid arthritis, we are not informed as to whether any potential confounding by imbalance of factors importantly related to health status, such as age, gender, rheumatoid factor status, extraarticular features, and treatment intensity, might account for some of the observed differences according to ethnicity. | ||
Abstract 1803: Increased Fracture and Osteoporosis Rates but Limited Prophylaxis in Rheumatoid Arthritis Patients Background: It is well recognized by the rheumatology community that patients with rheumatoid arthritis, particularly those with severe disease and those treated with corticosteroids, require monitoring and potent therapy for osteoporosis prevention and intervention. Methods: The investigators evaluated 5679 women with rheumatoid arthritis, who were part of a longitudinal study. 1424 women with osteoarthritis served as a comparison group. Queries related to osteoporosis were assessed by questionnaires every six months. Those participants reporting fractures received a follow-up phone call for purposes of validation. Of note, among the women in this longitudinal study of rheumatoid arthritis, less than one -quarter of the participants had undergone a bone mineral density evaluation in the preceding six month period. Results: After adjustment for age and recent prednisone therapy, women with rheumatoid arthritis were 40% more likely to report a diagnosis of osteoporosis than those women with osteoarthritis (odds ratio 1.4; 95% CI 1.2-1.6). Three factors were predictive of osteoporosis fracture, and were: prednisone use, higher Health Assessment Quotient scores, and longer disease duration. Further, no difference in diagnoses of osteoporosis, or of fracture rates, were observed between those who were white or black. Moreover, the black patients in this cohort were the least likely to be on osteoporosis therapy. | ||
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