Abstract
IntroductionEnvironmental exposures, including smoking, hormone-related factors, and metabolic factors, have been implicated in the etiology of rheumatoid arthritis (RA). A previous study has indicated that blood lipid levels may influence the development of RA. The objective of this study was to investigate the impact of serum total cholesterol and triglycerides on the risk of RA in a prospective study.MethodsAmong participants in a large population-based health survey (n = 33,346), individuals who subsequently developed RA were identified by linkage to four different registers and a structured review of the medical records. In a nested case-control study, with controls, matched for age, sex, and year of inclusion, from the health survey database, the relation between serum lipids (levels of total cholesterol and triglycerides) and future RA development was examined.ResultsIn total, 290 individuals (151 men and 139 women) whose RA was diagnosed a median of 12 years (range of 1–28) after inclusion in the health survey were compared with 1160 controls. Women with a diagnosis of RA during the follow-up had higher total cholesterol levels at baseline compared with controls: odds ratio (OR) 1.54 per standard deviation; 95 % confidence interval (CI) 1.22–1.94. This association remained statistically significant in multivariate models adjusted for smoking and a history of early menopause and in analyses stratified by rheumatoid factor status and time to RA diagnosis. Total cholesterol had no significant impact on the risk of RA in men (OR 1.03; 95 % CI 0.83–1.26). Triglycerides did not predict RA in men or women.ConclusionsA high total cholesterol was a risk factor for RA in women but not in men. This suggests that sex-specific exposures modify the impact of lipids on the risk of RA. Hormone-related metabolic pathways may contribute to RA development.Electronic supplementary materialThe online version of this article (doi:10.1186/s13075-015-0804-1) contains supplementary material, which is available to authorized users.
Highlights
Environmental exposures, including smoking, hormone-related factors, and metabolic factors, have been implicated in the etiology of rheumatoid arthritis (RA)
We have previously demonstrated that women with early menopause had an increased risk of RA compared with those with normal/late menopause in models adjusted for smoking, level of education, and length of breast-feeding, suggesting that hormone-related factors play a part in the pathogenesis [7]
There were no substantial differences in erythrocyte sedimentation rate (ESR) or self-reported health between cases and controls on the basis of data collected as part of the survey (Table 1)
Summary
Environmental exposures, including smoking, hormone-related factors, and metabolic factors, have been implicated in the etiology of rheumatoid arthritis (RA). A previous study has indicated that blood lipid levels may influence the development of RA. Rheumatoid arthritis (RA) is a chronic inflammatory disease of multifactorial etiology. Smoking is an established predictor of RA [3], and smoking and low socioeconomic status, as reflected by current occupation [4] or level of formal education [5], have been shown to have independent effects on disease development. It has been suggested that obesity may influence both RA onset and disease severity [8]. The effect of obesity may be different in men and women, and findings indicate a reduced risk of RA
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