![]() ![]() Using a separate cohort of 732 people screened for inclusion in the RA cohort of the Rochester Epidemiology Project (which used the 1987 ACR classification criteria) ( 1), we found the positive predictive value (PPV) of this definition to be 88%. We excluded 38 participants who reported RA on the baseline questionnaire but did not report RA on the follow-up questionnaire as those participants are likely to have misrepresented RA status. In this study, we defined cases of RA using a rules-based algorithm that combined self-reported RA on either the baseline or follow-up questionnaire with at least two RA diagnosis codes (714.0 or 714.9) 30 days apart. Most of the remaining participants were recruited from orthopedics. Of the 55,898 biobank participants, approximately 87% were recruited from primary care locations, including internal medicine, preventive medicine, family medicine, and obstetrics/gynecology. A computer program also evaluated for logical errors and incorrect skip patterns, flagging records for manual verification. Those with more than ten errors were returned to participants for correction. To ensure validity and quality of data, all questionnaires were visually examined for errors and omissions. Of those, 77% completed the follow-up questionnaire sent approximately four years later. ![]() Approximately 29% of those invited chose to participate and completed a baseline questionnaire, yielding the 55,898 current participants. Eligibility criteria included age 18 or older, ability to communicate in English, capacity to consent, and residence in the United States. ![]() Active recruitment occurred from April 2009 to December 2015 in both Minnesota and Florida. Questionnaire data for this study came from the Mayo Clinic Biobank repository ( 21). It received approval from the Mayo Clinic and Olmsted County Institutional Review Boards (17–010806 060-OMC-17) and complies with the Declaration of Helsinki. This case-control study followed the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guidelines for observational studies ( 20). We hypothesized that the association with asthma would be attenuated after adjusting for allergy and environmental pollutants that passive smoke at higher doses would be associated with RA and that earlier age of smoking onset would be associated with an increased RA risk. Specifically, we aimed to determine the association of RA with asthma after controlling for allergic disease, urban environment, and passive smoke passive smoke exposure both at home and work and age of starting smoking. Our aim was to clarify these gaps in knowledge related to the oral-respiratory factors that might mediate RA pathogenesis. Earlier age of smoking may also be important but has not yet been studied in patients with RA ( 19). None of these prior studies characterized work smoke exposure alone or contained information about both the duration and intensity to allow a dose-response analysis. Results of these studies conflict, with two suggesting an association between passive smoking and RA, and the other showing no association. Second, the association between personal smoking and RA has been well-established ( 15, 16), yet only three studies have investigated the association between passive smoke exposure and RA ( 10, 17, 18). It is unclear whether asthma is associated with RA after adjusting for these important confounders. Moreover, none have adjusted for second-hand cigarette smoke or urban pollution, which are known contributors both to RA ( 9– 12) and to asthma ( 13, 14). However, a major limitation of these previous studies is the lack of adjustment for allergic disease. However, several questions about this hypothesis of disease generation remain, which might help elucidate disease pathogenesis.įirst, several studies show an association between asthma and RA, which may be explained by a shared immunologic mechanism ( 4– 8). Seropositive RA in particular is hypothesized to originate from inflammation in the respiratory tract, resulting in autoantibody formation that later leads to disease ( 2, 3). Rheumatoid arthritis (RA) is one of the most common autoimmune diseases, affecting nearly 1 in 100 individuals ( 1). ![]()
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