Page 29 - THE EVOLUTION OF EARLY ARTHRITIS AND CARDIOVASCULAR RISK Samina A. Turk

Risk Factor
Family history
Genetic factors
Reproductive and hormonal factors
Environmental factors
Occupations and occupational expo- sures
Infections and vaccinations
Comorbidities
Comments
Risk increases with number of affected family members(30–33)
The longer the disease duration and the higher the age of the proband, the higher the risk(32)
Some studies did not find an association between relatives with RA and risk of RA(33,34,35)
Around 60 risk loci for RA are known, explaining 16% of total susceptibility(36)
65% of RA risk is thought to be heritable(36)
Risk is 2–4 times higher in women(37,38)
A protective effect of oral contraceptives is suggested(38–43)
High birth weight (more than 4 kg) increases risk(25,39)
Lower risk during pregnancy, compensated by an increased risk in the first postpartum year(40,41)
Complications during pregnancy may be related to a higher risk(42) Inconclusive or conflicting results for breastfeeding,(29,43–47) age at men- arche, irregular menstrual cycles and age at menopause, postmenopausal hormone use,(43,44,48–50) lower testosterone levels,(37,51–53) parity, age at first childbirth,(29,40–44,50,54,55) low birth weight, and being small for gestational age(54,56,57)
Smoking is the most established risk factor(58–61)
Smoking interacts with the strongest genetic risk factor (HLA-SE) in a dose-dependent manner to increase the risk of seropositive RA(62) Alcohol consumption (even in small quantities) protects(63–65)
High consumption of olive oil and fish (oil) protects(66–73)
Inconclusive results were found for vitamin D intake and ultraviolet B expo- sure,(74–78) antioxidant and trace element intake,(16,68,70,71,79–87) and exposure to toxic elements(86,87)
Farmers, blue collar workers, and hairdressers are at increased risk(88–92) Silica exposure gives increased risk(90,93)
Exposures that could not be related to RA: asbestos, mineral oil, organic dust, herbicides, insecticides, carbamates, organophosphates, carbaryl, gly- phosate, malathion,(94–97) and ambient air pollution(98–100)
Frequent infections may predispose(54,55)
One study reported increased risk after influenza vaccination(101)
Risks could not be quantified for: Ebstein-Barr virus infection,(102) hepati- tis C,(103,104) HIV,(105) Yersinia enterocolitica,(106) mycoplasma,(107) or Porphyromonas gingivalis infection of the gums,(108,109) and for immuni- zation (other than influenza)(101,110–114)
Diabetes types 1 and 2(29,115) and inflammatory lung disorders (88,116– 118) increase risk
Schizophrenia is protective(119)
Obesity and the related condition obstructive sleep apnea syndrome in- crease the risk(13,120–124)
Dyslipidemia is present before RA and predicts RA(125–129)
Other associations, such as for thyroid disease, are inconclusive(130)
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PREDICTION OF FUTURE RHEUMATOID ARTHRITIS
Table 1. Overview of evidence on risk factors for the development of RA 2
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