Abstract
BackgroundWe aimed to investigate the effects of ambient respiratory viral infections in the general population on rheumatoid arthritis (RA) development.MethodsData of weekly incident RA (2012–2013) were obtained from the Korean National Health Insurance claims database, and those of weekly observations on eight respiratory viral infections were obtained from the Korea Centers for Disease Control and Prevention database. We estimated the percentage change in incident RA associated with ambient mean respiratory viral infections using a generalized linear model, after adjusting for time trend, air pollution, and meteorological data.ResultsA total of 24,117 cases of incident RA (mean age 54.7 years, 18,688 [77.5%] women) were analyzed. Ambient respiratory viral infections in the population were associated with a higher number of incident RA over time, and its effect peaked 6 or 7 weeks after exposure. Among the 8 viruses, parainfluenza virus (4.8% for 1% respiratory viral infection increase, 95% CI 1.6 to 8.1, P = .003), coronavirus (9.2%, 3.9 to 14.8, P < .001), and metapneumovirus (44%, 2.0 to 103.4, P = .038) were associated with increased number of incident RA. The impact of these respiratory viral infections remained significant in women (3.8%, 12.1%, and 67.4%, respectively, P < .05) and in older patients (10.7%, 14.6%, and 118.2%, respectively, P < .05).ConclusionsAmbient respiratory viral infections in the population were associated with an increased number of incident RA, especially in women and older patients, suggesting that respiratory viral infections can be a novel environmental risk factor for the development of RA.
Highlights
Rheumatoid arthritis (RA) is an immune-mediated disease involving interactions between genetic and environmental factors [1, 2]
Seasonal tendency of incident rheumatoid arthritis (RA) The analysis revealed a seasonal tendency of incident RA in each year (Fig. 1)
The detection rate for ambient respiratory viral infections in the population was associated with an increased number of incident RA cases, which suggests a possible role for respiratory infections as a trigger for the development of RA
Summary
Rheumatoid arthritis (RA) is an immune-mediated disease involving interactions between genetic and environmental factors [1, 2]. It has been considered that a pre-clinical RA phase comprising the generation of autoantibodies in genetically susceptible individuals lasts months to years transitions to a clinical RA event by virtue of other driving factors [2]. These driving factors are currently poorly understood, but it is suspected that microvascular, neuroregulatory, microtrauma-related, or transient infectiondependent pathways are involved [2, 3]. Initial respiratory virus infections usually involve both the oral mucosa and the lungs, and this may be relevant to the generation of immune responses potentially associated with RA development. We aimed to investigate the effects of ambient respiratory viral infections in the general population on rheumatoid arthritis (RA) development
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