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02-05-2018 | Rheumatoid arthritis | Article

Smoking, body mass index, disease activity, and the risk of rapid radiographic progression in patients with early rheumatoid arthritis

Journal: Arthritis Research & Therapy

Authors: Emil Rydell, Kristina Forslind, Jan-Åke Nilsson, Lennart T. H. Jacobsson, Carl Turesson

Publisher: BioMed Central

Abstract

Background

Identification of risk factors for rapid joint destruction in early rheumatoid arthritis (RA) can be helpful for optimizing treatment, and improving our understanding of destructive arthritis and its mechanisms. The objective of this study was to investigate the relationship between early RA patient characteristics and subsequent rapid radiographic progression (RRP).

Methods

An inception cohort of patients with early RA (symptom duration < 12 months), recruited during 1995–2005 from a defined area (Malmö, Sweden), was investigated. Radiographs of the hands and feet were scored in chronological order according to the modified Sharp–van der Heijde score (SHS), by a trained reader. RRP was defined as an increase of ≥ 5 points in SHS per year.

Results

Two hundred and thirty-three patients were included. Radiographs were available from 216 patients at baseline, 206 patients at 1 year, and 171 patients at 5 years. Thirty-six patients (22%) had RRP up to 5 years. In logistic regression models, rheumatoid factor (RF) and anti-cyclic citrullinated peptides (anti-CCP), and increased erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) at baseline, predicted RRP over 5 years. Patients identified as overweight or obese had a significantly reduced risk of RRP up to 5 years (odds ratio (OR) 0.26; 95% confidence interval (CI) 0.11–0.63; adjusted for RF, baseline erosions, and ESR). Similar point estimates were obtained when stratifying for antibody status, and in models adjusted for smoking. A history of ever smoking was associated with a significantly increased risk of RRP up to 5 years, independent of body mass index (BMI) (OR 3.17; 95% CI 1.22–8.28; adjusted for BMI). At the 1-year follow-up, erosive changes, Disease Activity Score of 28 joints, Health Assessment Questionnaire, swollen joint count, and patient’s global assessment of disease activity and pain were also significantly associated with RRP up to 5 years.

Conclusions

A history of smoking, presence of RF and/or anti-CCP and early erosions, high initial disease activity and active disease at 1 year, all increase the risk of RRP. Patients with a high BMI may have a reduced risk of severe joint damage. This pattern was not explained by differences in disease activity or antibody status. The results of this study suggest independent effects of smoking and BMI on the risk of RRP.

van Steenbergen HW, Ajeganova S, Forslind K, Svensson B, van der Helm-van Mil AH. The effects of rheumatoid factor and anticitrullinated peptide antibodies on bone erosions in rheumatoid arthritis. Ann Rheum Dis. 2015;74:e3.CrossRefPubMed

Forslind K, Ahlmen M, Eberhardt K, Hafstrom I, Svensson B, BARFOT Study Group. Prediction of radiological outcome in early rheumatoid arthritis in clinical practice: role of antibodies to citrullinated peptides (anti-CCP). Ann Rheum Dis. 2004;63:1090–5.CrossRefPubMedPubMedCentral

Combe B, Dougados M, Goupille P, Cantagrel A, Eliaou JF, Sibilia J, et al. Prognostic factors for radiographic damage in early rheumatoid arthritis: a multiparameter prospective study. Arthritis Rheum. 2001;44:1736–43.CrossRefPubMed

Visser K, Goekoop-Ruiterman YP, de Vries-Bouwstra JK, Ronday HK, Seys PE, Kerstens PJ, et al. A matrix risk model for the prediction of rapid radiographic progression in patients with rheumatoid arthritis receiving different dynamic treatment strategies: post hoc analyses from the BeSt study. Ann Rheum Dis. 2010;69:1333–7.CrossRefPubMed

Tobon G, Saraux A, Lukas C, Gandjbakhch F, Gottenberg JE, Mariette X, et al. First-year radiographic progression as a predictor of further progression in early arthritis: results of a large national French cohort. Arthritis Care Res (Hoboken). 2013;65:1907–15.CrossRef

Lindqvist E, Eberhardt K, Bendtzen K, Heinegard D, Saxne T. Prognostic laboratory markers of joint damage in rheumatoid arthritis. Ann Rheum Dis. 2005;64:196–201.CrossRefPubMed

Silman AJ, Newman J, MacGregor AJ. Cigarette smoking increases the risk of rheumatoid arthritis. Results from a nationwide study of disease-discordant twins. Arthritis Rheum. 1996;39:732–5.CrossRefPubMed

Bergstrom U, Jacobsson LT, Nilsson JA, Berglund G, Turesson C. Pulmonary dysfunction, smoking, socioeconomic status and the risk of developing rheumatoid arthritis. Rheumatology (Oxford). 2011;50:2005–13.CrossRef

Nyhall-Wåhlin BM, Petersson IF, Nilsson JA, Jacobsson LT, Turesson C, BARFOT study group. High disease activity disability burden and smoking predict severe extra-articular manifestations in early rheumatoid arthritis. Rheumatology (Oxford). 2009;48:416–20.CrossRef

10.

Ruiz-Esquide V, Gomez-Puerta JA, Canete JD, Graell E, Vazquez I, Ercilla MG, et al. Effects of smoking on disease activity and radiographic progression in early rheumatoid arthritis. J Rheumatol. 2011;38:2536–9.CrossRefPubMed

11.

de Rooy DP, van Nies JA, Kapetanovic MC, Kristjansdottir H, Andersson ML, Forslind K, et al. Smoking as a risk factor for the radiological severity of rheumatoid arthritis: a study on six cohorts. Ann Rheum Dis. 2014;73:1384–7.CrossRefPubMed

12.

Saevarsdottir S, Rezaei H, Geborek P, Petersson I, Ernestam S, Albertsson K, et al. Current smoking status is a strong predictor of radiographic progression in early rheumatoid arthritis: results from the SWEFOT trial. Ann Rheum Dis. 2015;74:1509–14.CrossRefPubMed

13.

Westhoff G, Rau R, Zink A. Rheumatoid arthritis patients who smoke have a higher need for DMARDs and feel worse, but they do not have more joint damage than non-smokers of the same serological group. Rheumatology (Oxford). 2008;47:849–54.CrossRef

14.

Vesperini V, Lukas C, Fautrel B, Le Loet X, Rincheval N, Combe B. Association of tobacco exposure and reduction of radiographic progression in early rheumatoid arthritis: results from a French multicenter cohort. Arthritis Care Res (Hoboken). 2013;65:1899–906.CrossRef

15.

Svensson B, Andersson M, Forslind K, Ajeganova S, Hafstrom I, BARFOT study group. Persistently active disease is common in patients with rheumatoid arthritis, particularly in women: a long-term inception cohort study. Scand J Rheumatol. 2016;45:448–55.CrossRefPubMed

16.

Fautrel B, Granger B, Combe B, Saraux A, Guillemin F, Le Loet X. Matrix to predict rapid radiographic progression of early rheumatoid arthritis patients from the community treated with methotrexate or leflunomide: results from the ESPOIR cohort. Arthritis Res Ther. 2012;14:R249.CrossRefPubMedPubMedCentral

17.

Welsing PM, Landewe RB, van Riel PL, Boers M, van Gestel AM, van der Linden S, et al. The relationship between disease activity and radiologic progression in patients with rheumatoid arthritis: a longitudinal analysis. Arthritis Rheum. 2004;50:2082–93.CrossRefPubMed

18.

Kyburz D, Gabay C, Michel BA, Finckh A, physicians of SCQM-RA. The long-term impact of early treatment of rheumatoid arthritis on radiographic progression: a population-based cohort study. Rheumatology (Oxford). 2011;50:1106–10.CrossRef

19.

Mottonen T, Hannonen P, Korpela M, Nissila M, Kautiainen H, Ilonen J, et al. Delay to institution of therapy and induction of remission using single-drug or combination-disease-modifying antirheumatic drug therapy in early rheumatoid arthritis. Arthritis Rheum. 2002;46:894–8.CrossRefPubMed

20.

Jawaheer D, Olsen J, Lahiff M, Forsberg S, Lahteenmaki J, da Silveira IG, et al. Gender, body mass index and rheumatoid arthritis disease activity: results from the QUEST-RA Study. Clin Exp Rheumatol. 2010;28:454–61.PubMedPubMedCentral

21.

Ajeganova S, Andersson ML, Hafström I, BARFOT Study Group. Association of obesity with worse disease severity in rheumatoid arthritis as well as with comorbidities: a long-term followup from disease onset. Arthritis Care Res (Hoboken). 2013;65:78–87.CrossRef

22.

Heimans L, van den Broek M, le Cessie S, Siegerink B, Riyazi N, Han KH, et al. Association of high body mass index with decreased treatment response to combination therapy in recent-onset rheumatoid arthritis patients. Arthritis Care Res (Hoboken). 2013;65:1235–42.CrossRef

23.

Giles JT, Bartlett SJ, Andersen RE, Fontaine KR, Bathon JM. Association of body composition with disability in rheumatoid arthritis: impact of appendicular fat and lean tissue mass. Arthritis Rheum. 2008;59:1407–15.CrossRefPubMedPubMedCentral

24.

Kaufmann J, Kielstein V. Relation between body mass index and radiological progression in patients with rheumatoid arthritis. J Rheumatol. 2003;30:2350–5.PubMed

25.

Westhoff G, Rau R, Zink A. Radiographic joint damage in early rheumatoid arthritis is highly dependent on body mass index. Arthritis Rheum. 2007;56:3575–82.CrossRefPubMed

26.

van der Helm-van Mil AH, van der Kooij SM, Allaart CF, Toes RE, Huizinga TW. A high body mass index has a protective effect on the amount of joint destruction in small joints in early rheumatoid arthritis. Ann Rheum Dis. 2008;67:769–74.CrossRefPubMed

27.

de Rooy DP, van der Linden MP, Knevel R, Huizinga TW, van der Helm-van Mil AH. Predicting arthritis outcomes—what can be learned from the Leiden Early Arthritis Clinic? Rheumatology (Oxford). 2011;50:93–100.CrossRef

28.

Baker JF, Ostergaard M, George M, Shults J, Emery P, Baker DG, et al. Greater body mass independently predicts less radiographic progression on X-ray and MRI over 1-2 years. Ann Rheum Dis. 2014;73:1923–8.CrossRefPubMedPubMedCentral

29.

Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988;31:315–24.CrossRefPubMed

30.

Rydholm M, Book C, Wikström I, Jacobsson L, Turesson C. Despite early improvement, patients with rheumatoid arthritis still have impaired grip force 5 years after diagnosis. Arthritis Care Res (Hoboken). 2017;70:491–498. https://doi.org/10.1002/acr.23318.

31.

Ekdahl C, Eberhardt K, Andersson SI, Svensson B. Assessing disability in patients with rheumatoid arthritis. Use of a Swedish version of the Stanford Health Assessment Questionnaire. Scand J Rheumatol. 1988;17:263–71.CrossRefPubMed

32.

Smolen JS, Aletaha D, Bijlsma JW, Breedveld FC, Boumpas D, Burmester G, et al. Treating rheumatoid arthritis to target: recommendations of an international task force. Ann Rheum Dis. 2010;69:631–7.CrossRefPubMedPubMedCentral

33.

Geborek P, Nitelius E, Noltorp S, Petri H, Jacobsson L, Larsson L, et al. Population based studies of biological antirheumatic drug use in southern Sweden: comparison with pharmaceutical sales. Ann Rheum Dis. 2005;64:1805–7.CrossRefPubMedPubMedCentral

34.

van Gestel AM, Prevoo ML, van ‘t Hof MA, van Rijswijk MH, van de Putte LB, van Riel PL. Development and validation of the European League Against Rheumatism response criteria for rheumatoid arthritis. Comparison with the preliminary American College of Rheumatology and the World Health Organization/International League Against Rheumatism Criteria. Arthritis Rheum. 1996;39:34–40.CrossRefPubMed

35.

Vastesaeger N, Xu S, Aletaha D, St Clair EW, Smolen JS. A pilot risk model for the prediction of rapid radiographic progression in rheumatoid arthritis. Rheumatology (Oxford). 2009;48:1114–21.CrossRef

36.

Carpenter L, Nikiphorou E, Sharpe R, Norton S, Rennie K, Bunn F, et al. Have radiographic progression rates in early rheumatoid arthritis changed? A systematic review and meta-analysis of long-term cohorts. Rheumatology (Oxford). 2016;55:1053–1065. https://doi.org/10.1093/rheumatology/kew004.

37.

Mattey DL, Hutchinson D, Dawes PT, Nixon NB, Clarke S, Fisher J, et al. Smoking and disease severity in rheumatoid arthritis: association with polymorphism at the glutathione S-transferase M1 locus. Arthritis Rheum. 2002;46:640–6.CrossRefPubMed

38.

Haye Salinas MJ, Retamozo S, Alvarez AC, Maldonado Ficco H, Dal Pra F, Citera G, et al. Effects of cigarette smoking on early arthritis: a cross-sectional study-data from the Argentine Consortium for Early Arthritis (CONAART). Rheumatol Int. 2015;35:855–9.CrossRefPubMed

39.

Papadopoulos NG, Alamanos Y, Voulgari PV, Epagelis EK, Tsifetaki N, Drosos AA. Does cigarette smoking influence disease expression, activity and severity in early rheumatoid arthritis patients? Clin Exp Rheumatol. 2005;23:861–6.PubMed

40.

Saag KG, Cerhan JR. Cigarette smoking and rheumatoid arthritis severity. Ann Rheum Dis. 1997;56:463–9.CrossRefPubMedPubMedCentral

41.

Manfredsdottir VF, Vikingsdottir T, Jonsson T, Geirsson AJ, Kjartansson O, Heimisdottir M, et al. The effects of tobacco smoking and rheumatoid factor seropositivity on disease activity and joint damage in early rheumatoid arthritis. Rheumatology (Oxford). 2006;45:734–40.CrossRef

42.

Quintana-Duque MA, Rondon-Herrera F, Calvo-Paramo E, Yunis JJ, Varela-Narino A, Iglesias-Gamarra A. The impact of smoking on disease activity, disability, and radiographic damage in rheumatoid arthritis: is cigarette protective? Rheumatol Int. 2017;37:2065–70.CrossRefPubMed

43.

Levitsky A, Brismar K, Hafstrom I, Hambardzumyan K, Lourdudoss C, van Vollenhoven RF, et al. Obesity is a strong predictor of worse clinical outcomes and treatment responses in early rheumatoid arthritis: results from the SWEFOT trial. RMD Open. 2017;3:e000458.CrossRefPubMedPubMedCentral

44.

Mangnus L, Nieuwenhuis WP, van Steenbergen HW, Huizinga TW, Reijnierse M, van der Helm-van Mil AH. Body mass index and extent of MRI-detected inflammation: opposite effects in rheumatoid arthritis versus other arthritides and asymptomatic persons. Arthritis Res Ther. 2016;18:245.CrossRefPubMedPubMedCentral

45.

Giles JT, Allison M, Bingham CO 3rd, Scott WM Jr, Bathon JM. Adiponectin is a mediator of the inverse association of adiposity with radiographic damage in rheumatoid arthritis. Arthritis Rheum. 2009;61:1248–56.CrossRefPubMedPubMedCentral

46.

Meyer M, Sellam J. Serum level of adiponectin is a surrogate independent biomarker of radiographic disease progression in early rheumatoid arthritis: results from the ESPOIR cohort. Arthritis Res Ther. 2013;15:R210.CrossRefPubMedPubMedCentral

47.

Vidal C, Barnetche T, Morel J, Combe B, Daien C. Association of body mass index categories with disease activity and radiographic joint damage in rheumatoid arthritis: a systematic review and metaanalysis. J Rheumatol. 2015;42:2261–9.CrossRefPubMed

48.

Landewe R, van der Heijde D, Klareskog L, van Vollenhoven R, Fatenejad S. Disconnect between inflammation and joint destruction after treatment with etanercept plus methotrexate: results from the trial of etanercept and methotrexate with radiographic and patient outcomes. Arthritis Rheum. 2006;54:3119–25.CrossRefPubMed

49.

Rezaei H, Saevarsdottir S, Forslind K, Albertsson K, Wallin H, Bratt J, et al. In early rheumatoid arthritis, patients with a good initial response to methotrexate have excellent 2-year clinical outcomes, but radiological progression is not fully prevented: data from the methotrexate responders population in the SWEFOT trial. Ann Rheum Dis. 2012;71:186–91.CrossRefPubMed

50.

Finckh A, Liang MH, van Herckenrode CM, de Pablo P. Long-term impact of early treatment on radiographic progression in rheumatoid arthritis: a meta-analysis. Arthritis Rheum. 2006;55:864–72.CrossRefPubMed