Association Between Life Events and Rheumatoid Arthritis, Results From The EIRA Case Control Study

Annmarie Wesley¹, Camilla Camilla Bengtsson¹, Marie Holmqvist², Töres Theorell³, Saedis Saevarsdottir⁴, Eva Skillgate¹, Lars Klareskog⁵, Lars Alfredsson⁶ and Sara Wedrén⁷, ¹Institute of Enviornmental Medicine, Karolinska Insitutet, Stockholm, Sweden, ²Karolinska Institutet, Stockholm, Sweden, ³Public Health Sciences, Karolinska Insitutet, Stockholm, Sweden, ⁴Rheumatology Unit, Dept. of Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden, ⁵Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden, ⁶Institute of Enviornmental Medicine/Cardiovascular epidemiology, Karolinska Insitutet, Stockholm, Sweden, ⁷Rheumatology unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: Epidemiologic methods, Rheumatoid arthritis (RA) and stress

Session Information

Title: Rheumatoid Arthritis: Human Etiology and Pathogenesis II

Session Type: Abstract Submissions (ACR)

Background/Purpose: The association between life events and rheumatoid arthritis (RA) has previously been studied with contradicting results. No previous study have investigated the impact of life events on risk of developing RA in the two major subsets of RA defined by the presence or absence of anti-citrullinated protein antibodies (ACPA) (Klareskog, Catrina et al. 2009). We aimed to investigate the association between life events and the risk for RA with and without ACPAs.

Methods: We used 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=2774) diagnosed by rheumatologists according to the American College of Rheumatology 1987 criteria for RA and randomly selected controls (n=3911) matched to cases by age, sex, and area of residence. All answered a questionnaire, including questions about 15 life events. We calculated odds ratios (OR) and 95% confidence intervals (CI) from unconditional logistic regression models adjusted for matching variables and confounding factors.

Results: Having experienced a life event was weakly associated with ACPA positive as well as ACPA negative RA, OR 1.1, 95%CI 1.0-1.2, and 1.2 95%CI 1.0-1.4, respectively. The association with ACPA negative RA was stronger with increasing number of events (OR 1.4 95%CI 1.1-1.7 for having experienced 3 or more events vs. none). Several particular life events were associated with RA (e.g., “conflict at work”, “change of residence”, “change of workplace”, and “increased responsibility at work”). The results were more consistent in women than in men.

Conclusion: Our study lends support to the concept that stress, here measured as life events, is associated with an increased risk of developing RA.

Klareskog, L., A. I. Catrina, et al. (2009). “Rheumatoid arthritis.” Lancet 373(9664): 659-672.

Disclosure:

A. Wesley,
None;

C. Camilla Bengtsson,
None;

M. Holmqvist,
None;

T. Theorell,
None;

S. Saevarsdottir,
None;

E. Skillgate,
None;

L. Klareskog,

No own commercial interests,

L. Alfredsson,
None;

S. Wedrén,
None.

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