Research On The Influence Of Smoking On Anti-CCP Antibodies And Disease Activities Of Han Rheumatoid Arthritis Patient

Objective:Rheumatoid arthritis (RA) is a kind of chronic disabling autoimmune disease which characterized by synovitis and chronic polyarthritis as the main clinical manifestations. This disease mostly occurs in person aged between20and50with a significant sexual difference:the incidence rate of females is2～3times higher than males, especially in elder females. A lot of research has found that the onset of RA is associated with immune genetic, bacterial, viral, metabolic abnormality of sex hormones, enzymes, mental state and environmental impact. However, RA still cannot be clinically cured and actively prevented currently. Many epidemiologic studies showed that pathogenic factors may be diverse in different countries and ethenic group. It has been reported that long-term smoking, seasonal fluctuation, cold and/or damp environment, injury, premature birth, diabetes, chronic exposure to lead/mercury/arsenic, diet could induce RA. A large number of studies showed that smoking (especially heavy smoking) would not only increase the occurrence risk of RA, but also increase the risk of RA progress. These studies also showed due to lack of the gene to code multiple chemical enzymes, some smokers bore more risk of taking severe RA than smokers with it. In addition to this, smoking has certain effect on the restrain of estrogen which could weaken immunity to raise the occurrence risk of RA. Although the impact of smoking on RA was reported abroad, it is still no related research in China. The main purpose of this subject is to research the influence of smoking on anti-CCP antibodies and disease activities of Han RA patient in China through case-control study, and provide the theoretical basis for preventing the incidence of RA in the perspective of RA etiology.Methods:1.1205cases of subjects were chosen and divided into two groups:(1) RA group (RA patient group of1205cases) Measured with smoking status, the RA group was divided into smoking RA group (811cases) and non-smoking RA group (394cases); Measured with the serological rheumatoid factor, the RA group was also divided into RF positive RA patient group of822cases and negative group383cases; Measured with anti-CCP antibody factor, the RA group was divided into ACPA positive RA patient group of736cases and negative group of469cases. The ACPA+RA group was also divided into smoking group (529cases) and non-smoking group (207cases). The ACPA+RA group was classified into1-9pack per years (159cases),10-19pack per years (144cases),20+pack per years (226cases) according to smoking amount.(2) Normal control group In this group,872cases of healthy volunteers were selected. This gourp was also divided into non-smoking group (347cases) and smoking group (525cases). The smoking group was divided into1-9pack per years (219cases),10-19pack per years (134cases),20+pack per years (172cases).2. Taking the method of face to face questionnaire survey combined with relative clinical laboratory examination which includes recording the time point of starting and/or quitting smoking, duration of smoking, daily/former/present smoking amount in questionnaire and examining rheumatoid factor, anti-CCP antibodies, ESR, C-reactive protein in laboratory examination.3. Survey contents(1) General data recording:name, gender, age, nation, education, occupation, living environment, time point of starting and/or quitting smoking, duration of smoking, daily/former/present smoking amount(2) Clinical characteristics:age of onset, course record, number of swollen joints (0-28), number of tender joints(0-28), joint deformity number (0-64), DAS28score (DAS28=0.56*√28+0.28*√(sw28)+0.7*In(ESR)+0.014*GH, Low activity2.6～3.2Moderate activity3.2～5.1High activity>5.1), condition of the overall score (0～100mm).4. Statistical data treatment:the risk factors were analyzed by univariate chi-square test and calculate the odds ratio (OR) associated with95%confidence intervals (95% CI). The experimental part of the data was indicated as x±s and applied independent sample t-test according to the homogeneity of variance test results between the two group. All data was processed by SPSS17.0statistical software and P<0.05represented that the difference was statistically significant.Results:1. Smoking combined RA patients:rate of anti-CCP antibody positive was65.23%, which was positively correlated with the amount of smoking and higher than the non-smoking combined RA patients.2. Smoking combined RA patients:rate of rheumatoid factor positive was70.78%, significantly higher than the non-smoking combined RA patients.3. Smoking combined RA patients:joint swelling/tenderness/deformities number, DAS-28score, VAS and acute phase reactant (ESR/CRP) were higher than non-smoking combined RA patients.Conclusions:1. Smoking may be the risk factors of rheumatoid arthritis.2. Smoking may stimulate the generation of anti-CCP antibody and rheumatoid factor.3. Smoking has certain impacts on the disease development of RF-positive RApatients.Conclusions:1Smoking may be risk factors of rheumatoid arthritis.2Smoking may promote anti-CCP antibody and rheumatoid factor production.3Smoking on RF-positive rheumatoid arthritis patients have a certain impact on the development of the disease.