Association Between Physical Work Load and Rheumatoid Arthritis, Results From The EIRA Case Control Study

Annmarie Wesley¹, Henrik Källberg², Camilla Bengtsson², Eva Skillgate¹, Johan Rönnelid³, Mohammed Mullazehi⁴, Lars Klareskog⁵, Lars Alfredsson², Saedis Saevarsdottir⁶ and Sara Wedren^7,8, ¹Institute of Enviornmental Medicine, Karolinska Insitutet, Stockholm, Sweden, ²Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden, ³Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden, ⁴Uppsala University, Uppsala, Sweden, ⁵Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden, ⁶Rheumatology Unit, Dept. of Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden, ⁷Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden, ⁸Department of Medicine, Karolinska Institutet, Stockholm, Sweden

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: Environmental factors, epidemiologic methods and rheumatoid arthritis (RA)

Session Information

Title: Rheumatoid Arthritis: Human Etiology and Pathogenesis II

Session Type: Abstract Submissions (ACR)

Background/Purpose: The association between occupation and RA has previously been investigated where occupations associated with a physical work load (quarry workers, construction workers, assistant nurses, freight, and transport workers) have shown association with risk of developing RA. From a biological standpoint physical challenges to the joint and ensuing tissue injury may expose antigenic molecules that could trigger and /or perpetuate local activation of the immune system.

The aim of present study was to investigate the association between physical work load and the risk of developing rheumatoid arthritis (RA) with and without antibodies against cyclic citrullinated peptide (anti-CCP) and against native type II collagen (anti-CII).

Methods: A population based case-control study of individuals aged 18 to 70 years, living in geographically defined parts of Sweden between May 1996 and November 2009. We included incident cases (n=2268) diagnosed by rheumatologists according to the American College of Rheumatology 1987 criteria for RA and controls, matched to cases by age, sex, and area of residence (n=3176). All answered an extensive questionnaire, including questions about physical work load five years prior to study inclusion. In addition, we classified the individuals with regard to physical work load using Nordic Occupational Classification Code (NYK). We calculated odds ratios (OR) and 95% confidence intervals (CI) associated with physical work load by means of unconditional logistic regression models adjusted for matching factors, smoking, and education. Anti-CCP and anti-CII were measured by ELISA.

Results: Perceived physical work load was significantly associated with RA independent of anti-CCP-status OR 1.3 (95% CI 1.2-1.5) for anti-CCP positive RA and OR 1.5 (95% CI 1.3-1.8) for anti-CCP negative RA. The association was more pronounced in men. The occurrence of anti-CII showed no association to physical work load among RA patients.

Conclusion: Physical work load is associated with an increased risk to developing RA irrespective of anti-CCP status.

Disclosure:

A. Wesley,
None;

H. Källberg,
None;

C. Bengtsson,
None;

E. Skillgate,
None;

J. Rönnelid,
None;

M. Mullazehi,
None;

L. Klareskog,

No own commercial interests,

L. Alfredsson,
None;

S. Saevarsdottir,
None;

S. Wedren,
None.

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