Open AccessAssociations of cigarette smoking with rheumatoid arthritis in African Americans
Author(s) -
Mikuls Ted R.,
Sayles Harlan,
Yu Fang,
LeVan Tricia,
Gould Karen A.,
Thiele Geoffrey M.,
Conn Doyt L.,
Jonas Beth L.,
Callahan Leigh F.,
Smith Edwin,
Brasington Richard,
Moreland Larry W.,
Reynolds Richard J.,
Bridges S. Louis
Publication year - 2010
Publication title -
arthritis & rheumatism
Language(s) - English
Resource type - Journals
eISSN - 1529-0131
pISSN - 0004-3591
DOI - 10.1002/art.27716
Subject(s) - medicine , rheumatoid arthritis , autoantibody , odds ratio , confidence interval , relative risk , cigarette smoking , logistic regression , demography , immunology , antibody , sociology
Objective To examine the associations of cigarette smoking with rheumatoid arthritis (RA) in African Americans, and to determine whether this association is impacted by the HLA–DRB1 shared epitope (SE). Methods Smoking status, cumulative smoking exposure, and SE status were determined in African American patients with RA and African American healthy controls. Associations of smoking with RA were examined using age‐ and sex‐adjusted logistic regression analyses. Additive and multiplicative SE–smoking interactions were examined. Results After adjustment for age and sex, ever smoking (odds ratio [OR] 1.45, 95% confidence interval [95% CI] 1.07, 1.97) and current smoking (OR 1.56, 95% CI 1.07, 2.26), relative to never smoking, were more common in African American patients with RA (n = 605) than in controls (n = 255). The association of smoking with RA was limited to those with a cumulative exposure exceeding 10 pack‐years, associations that were evident both in autoantibody‐positive and in autoantibody‐negative disease. There was evidence of a significant additive interaction between SE status and heavy smoking (≥10 pack‐years) in relation to RA risk (attributable proportion [AP] due to interaction 0.58, P = 0.007), with similar results for the additive interaction between SE status and ever smoking (AP 0.47, P = 0.006). There was no evidence of multiplicative interactions. Conclusion Among African Americans, cigarette smoking is associated not only with the risk of autoantibody‐positive RA but also with the risk of autoantibody‐negative disease. The risk of RA attributable to smoking is limited to African Americans with more than 10 pack‐years of exposure and is more pronounced among individuals positive for the HLA–DRB1 SE.