Rheumatoid Arthritis Risk Report: 5 Pluses and Minuses

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.