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Occupational and environmental aspects on the aetiology of rheumatoid arthritis
Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
2003 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Two questionnaire-based case-referent studies were performed to primarily assess the impact from occupational and environmental exposures on the aetiology of rheumatoid arthritis (RA). The two studies included prevalent and incident cases of RA, respectively. All determinants were evaluated separately for the two materials, and potential occupational risk factors were also analysed after pooling of the two studies. Most associations found between occupational exposures and RA regarded men. Increased risks for RA were seen for exposure to asphalt (OR 6.0, 95% CI 1.6-27.7), vibrations (OR 2.1, 95% CI 1.4-3.3), crops and/or forage (OR 2.0, 95% CI 1.3-3.0), mineral dust (OR 1.8, 95 % CI 1.0-3.2). and mineral oil (OR 1.5, 95 % CI 1.0-2.3 ), with dose-response relationships between RA and exposure to mineral dust and vibrations. Occupational categories at increased risk of RA among men were conductors, freight and transport workers (OR 4.6, 95 % CI 1.4-15.0), pulp and paper workers (OR 3.9, 95 % CI 1.2-12.8), and farmers (OR 2.3, 95 % CI 1.4-3.5). Regarding women, increased risks for RA were seen for exposure to meat (OR 2.2, 95 % CI 1.0-4.9), hairdressing chemicals (OR 1.7, 95 % CI 0.7-4.5), and for hairdressers (OR 1.7, 95 % CI 0.7-4.0). The results refer to the pooled material.

Regarding leisure-time activities, an increased risk was seen for mineral oil exposure among men in the study with incident cases (OR 2.0, 95 % CI 0. 7-6.2 ). In this study, an association was also seen for men for having ever used a private well (OR 1.5, 95 % CI 0.8-2.9). In the study with prevalent cases, associations were seen for both sexes for having been exposed to water from a private well at time of birth (OR 1.5, 95 % CI 0.9-2.4 for women, and OR 2.8, 95 % CI 1.5-5.2 for men). The risk of RA was increased for men with previous exposure to mould indoors (OR 4.6, 95 % CI 1,1-20.2 ), and an association was also seen for long time use of hair dyes and/or bleach among women (OR 1.9, 95 % CI 0.8-4.5). In the study with incident cases, the risk for RA was increased among men with previous use of skin lotion (OR 3.0, 95 % CI 0.9-9.8).

For both sexes, increased risks for RA were seen for current and previous smoking, with even higher ORs for seropositive cases among men. In the study with incident cases, male subjects with more than 20 pack years of smoking had an OR of 2.5 (95 % CI 1.2-5.1), corresponding to an OR of 1.6 (95% CI 0.9-3.1) among women. There was a tendency towards increasing risks with increasing number of pack years for men in both studies, with significant tests for trend in the study with prevalent cases. For both sexes, higher schooling resulted in a decreased risk for RA.

The relationship between RA and allergy was evaluated more extensively in a cross-sectional study, and negative associations between RA and certain manifestations of hay fever were found. An almost significantly decreased risk for allergy was found in the study with prevalent cases with both sexes included in the analysis (OR 0.6, 95 % CI 0.4-1.0). Regarding other comorbidity, there were positive associations between RA and self-repotted thyroid conditions (OR 3.5. 95 % CI 1.1-10.8) and previous treatment with insulin (OR 10.2, 95 % CI 1.7-60.8) among women in the study with prevalent cases. In the cross-sectional study, there was an association between RA and diabetes (OR 2.8. 95 & CI 0.9-8.9), with both sexes included in the analysis. Associations were seen between previous joint trauma and RA for women in both case-referent studies (OR 2.5, 95 % CI 1.0-6.6 in the study with prevalent cases) as well as for men in the study with incident cases (OR 2.2, 95% CI 0.6-7.1).

Altogether, the determinants conveying the risk for RA differ between sexes. RA is a condition most often affecting women. but the present studies, as well as previous research, have established that most extemal factors evaluated so far seem to be of more importance for men than women.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet , 2003. , 94 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 807
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-26666Local ID: 11232ISBN: 91-7373-494-2 (print)OAI: oai:DiVA.org:liu-26666DiVA: diva2:247215
Public defence
2003-10-09, Aulan, Hälsans hus, Universitetssjukhuset, Linköping, 09:00 (Swedish)
Opponent
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-10-16Bibliographically approved
List of papers
1. Occupational determinants for rheumatoid arthritis
Open this publication in new window or tab >>Occupational determinants for rheumatoid arthritis
2000 (English)In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 26, no 3, 243-249 p.Article in journal (Refereed) Published
Abstract [en]

Objectives The aim of the present study was to evaluate possible occupational determinants for rheumatoid arthritis according to lifetime occupational history.

Methods The cases were identified retrospectively from 1980 to 1995 at the University Hospital in Linköping, Sweden. The study comprised 422 cases and 859 randomly selected referents. Exposure data were collected through a postal questionnaire.

Results For men, occupations with increased, although nonsignificant, odds ratios (OR) were farmers or farm workers [OR 1.8, 95% confidence interval (95% CI) 1.0-3.5], textile workers (OR 2.0, 95% CI 0.3-16.2), asphalters (OR 14.0, 95% CI 1.2-799.0 without latency requirement), and employees at service stations (OR 2.2, 95% CI 0.5-9.5). Among the women, hairdressers and beauticians (OR 2.7, 95% CI 0.8-8.6) had an increased risk for rheumatoid arthritis, as well as those exposed to hairdressing chemicals (OR 3.0, 95% CI 1.0-9.4) and meat products (OR 2.0, 95% CI 1.0-4.0).

Conclusion Several of the findings in this study are in accordance with those of previous studies. The increased risks of rheumatoid arthritis for asphalters and employees at service stations are however new associations previously not described in the literature.

Keyword
asphalt, case-referent study, farmers, nonresponse bias, questionnaire
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-26087 (URN)10.5271/sjweh.538 (DOI)10546 (Local ID)10546 (Archive number)10546 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
2. Comorbidity and lifestyle, reproductive factors, and environmental exposures associated with rheumatoid arthritis
Open this publication in new window or tab >>Comorbidity and lifestyle, reproductive factors, and environmental exposures associated with rheumatoid arthritis
2001 (English)In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 60, no 10, 934-939 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE To evaluate the influence of lifestyle, reproduction, and some external factors on the development of rheumatoid arthritis (RA) and to describe its comorbidity.

METHODS Cases were identified retrospectively from 1980 to 1995 at the University Hospital in Linköping, Sweden. The study comprised 422 cases and 859 randomly selected population referents. Data on possible aetiological factors and comorbidity were collected by postal questionnaire.

RESULTS The response rates were 67% among cases and 59% among referents. A decrease in the occurrence of atopic allergy was seen in the cases (odds ratio (OR) 0.6, 95% confidence interval (CI) 0.4 to 1.0). There was a positive association between RA and insulin treatment (OR 10.2, 95% CI 1.7 to 60.8) in women, and women with a short fertile period had an increased risk of RA (OR 2.5, 95% CI 1.1 to 5.4). Current and previous smoking were associated with increased risks for RA in both sexes, and in men a dose-response relationship was found with number of tobacco pack years (p for trend <0.005). The risk for RA decreased with increasing level of education in both men and women. Increased risks were seen in men born into households with private wells (OR 2.8, 95% CI 1.5 to 5.2), residentially exposed to mould (OR 4.6, 95% CI 1.1 to 20.2), or exposed to farm animals (OR 3.3, 95% CI 0.7 to 16.6). In women there were positive associations between RA and reporting a previous joint injury (OR 2.5, 95% CI 1.0 to 6.6) and prolonged exposure to hair dyes (OR 1.9, 95% CI 0.8 to 4.5).

CONCLUSIONS RA, a disease with features of T helper 1 (Th1) dominated immune response, was inversely associated with atopic allergy, a Th2 dominated condition, while there were indications of a strong positive association with Th1 related diabetes mellitus. The results support a causal relationship between smoking and RA. The level of education was inversely associated with RA, while there was a positive association between RA and certain residential factors in men and a short fertile period in women.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-26088 (URN)10.1136/ard.60.10.934 (DOI)10547 (Local ID)10547 (Archive number)10547 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
3. Occupations and exposures in the work environment as determinants for rheumatoid arthritis
Open this publication in new window or tab >>Occupations and exposures in the work environment as determinants for rheumatoid arthritis
2004 (English)In: Occupational and Environmental Medicine, ISSN 1351-0711, E-ISSN 1470-7926, Vol. 61, no 3, 233-238 p.Article in journal (Refereed) Published
Abstract [en]

Background and Aims: Several occupational categories have been associated with rheumatoid arthritis (RA); this study was conducted to further evaluate these associations.

Methods: Lifelong occupational history together with exposure experiences were collected through a postal questionnaire answered by 293 incident cases and 1346 population based referents. Occupational determinants were evaluated through stratified and multivariate analyses; pooled analyses with previously gathered data on 422 prevalent cases and 858 referents were also performed.

Results: In both materials, significantly increased logistic odds ratios (LORs) were seen for male conductors, freight and transport workers (LOR 17.8, 95% CI 1.5 to 207.8 and LOR 4.7, 95% CI 1.4 to 16.3, respectively), and farmers and farm workers (LOR 2.4, 95% CI 1.1 to 5.2, and LOR 2.2, 95% CI 1.3 to 3.5, respectively). Among women, increased LORs were seen in the separate and the pooled material for printmakers and process engravers (LOR 5.5, 95% CI 0.9 to 32.6, and LOR 3.0, 95% CI 0.9 to 10.3, respectively). Increased risks were seen in both materials for men exposed to asbestos (LOR 2.5, 95% CI 1.0 to 6.8, and LOR 1.6, 95% CI 0.8 to 3.3, respectively), and vibrations (LOR 2.0, 95% CI 0.9 to 4.4, and LOR 2.2, 95% CI 1.3 to 3.8, respectively). The risk for RA increased with increasing duration of exposure to vibrations and mineral dust, respectively.

Conclusions: There was evidence of a causal relation between exposures to vibrations and mineral dust and development of RA among men. Occupational factors seem to be aetiologically more important for men, and most occupations at risk involve multiple exposures. Several exposures associated with an increased risk for RA are frequent among farmers, and some of the occupations at risk include exposure to organic dust.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-22019 (URN)10.1136/oem.2003.007971 (DOI)1047 (Local ID)1047 (Archive number)1047 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved
4. Aetiological factors of importance for the development of rheumatoid arthritis
Open this publication in new window or tab >>Aetiological factors of importance for the development of rheumatoid arthritis
2004 (English)In: Scandinavian Journal of Rheumatology, ISSN 0300-9742, E-ISSN 1502-7732, Vol. 33, no 5, 300-306 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To evaluate exposure to external factors associated with risk or prevention of rheumatoid arthritis (RA).

Methods: Two hundred and ninety‐three incident cases of RA and 1346 population‐based referents were included in a case‐referent study, in which previous exposure experiences were collected through a postal questionnaire.

Results: An inverse association between RA and additional schooling after compulsory school was seen for men. Current smoking was associated with significantly increased risks of RA for men and women [odds ratio (OR) 2.9, 95% confidence interval (CI) 1.4–6.4, and OR 1.8, 95% CI 1.1–2.9, respectively], as was previous smoking for men (OR 2.3, 95% CI 1.2–4.4). There were also indications of relationships between previous use of a private well and RA in both men and women.

Conclusion: Several previously published associations have been reproduced in the present study, which also generates some new hypotheses that suggest further research.

Keyword
aetiological factors, case‐referent study, educational level, environment, epidemiology, private well, rheumatoid arthritis, smoking
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-22028 (URN)10.1080/03009740310004748 (DOI)1066 (Local ID)1066 (Archive number)1066 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved
5. Allergic manifestations in patients with rheumatoid arthritis
Open this publication in new window or tab >>Allergic manifestations in patients with rheumatoid arthritis
Show others...
2003 (English)In: Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), ISSN 0903-4641, E-ISSN 1600-0463, Vol. 111, no 10, 940-944 p.Article in journal (Refereed) Published
Abstract [en]

A functional dichotomy between Th1- and Th2-type immune responses has been suggested. This study was performed to investigate whether rheumatoid arthritis (RA), a disease with indications of Th1-deviated immune activation, is inversly related to atopic conditions which are Th2-mediated. Two hundred and sixty-three adult cases of RA, fulfilling the American Rheumatism Association (ARA) 1987 Revised Classification Criteria for RA, were identified in 1995 and compared with 541 randomly selected population referents. The presence of atopic manifestations was established through a postal questionnaire and by demonstrating circulating IgE antibodies to common allergens. RA was inversely associated with certain manifestations of rhinitis, which were regarded as the most reliable indicators of atopic disease in the present study. However, no negative association was seen between RA and asthma and eczema, respectively. The main results give some support for an inverse relationship between RA and rhinitis. The prevalence of circulating IgE antibodies was however similar in cases and controls, suggesting that the T-cell commitment mainly occurs in the affected organs.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-26436 (URN)10.1034/j.1600-0463.2003.1111004.x (DOI)10979 (Local ID)10979 (Archive number)10979 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved

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