作者：Raphaèle Seror，et al 翻译：北医三院代丽怡

摘要：目的：调查吸烟状况（包括儿童和成人时期被动吸烟情况）与类风湿关节炎（RA）发病风险之间的关系。

方法：此队列包括自1990年以来随访的98995名女性志愿者。每2-3年发送一次自我管理调查问卷，包括医疗事件、一般情况、生活方式和环境特征。在三份连续的问卷中收集确诊为RA的患者，并确认这些患者是否应用药物治疗。采用年龄调整后的Cox模型，将吸烟状态视为一个时间依赖性变量，评估RA的发病风险。

结果：在71248名女性中，371名确诊为RA。没有被动吸烟史的吸烟者患RA的风险增加[1.38（95%可信区间1.10，1.74）]。在从不吸烟的患者中，儿童时期被动吸烟者及成人主动吸烟者与RA患病临界危险性相关性范围大致相同，危险比（HR）为1.43（95%CI 0.97，2.11）。曾经有过儿童期被动吸烟史的吸烟者比无儿童时期被动吸烟史的吸烟者患RA的风险更高[HR 1.67（95%CI 1.17，2.39）]，但无显著差异（p=0.30）。在有儿童时期被动吸烟史的吸烟者中RA发病年龄更早。

结论：这项研究证实了主动吸烟会增加患RA的风险。这首次表明，儿童时期被动接触烟草也可能增加少量吸烟者甚至不吸烟者患RA的风险。我们的研究结果强调了避免儿童接触任何烟草环境的重要性，尤其是那些有RA家族史的儿童。

附原文：Abstract Objectives：Toinvestigate the link between smoking status, including childhood and adultpassive exposure, and the risk of incident RA.

Methods：The French E3N cohort includes 98 995female volunteers prospectively followed since 1990. Self-administeredquestionnaires sent every 2–3 years collected medical events, general,lifestyle and environmental characteristics. RA diagnoses were collected inthree successive questionnaires and confirmed if women received reimbursementfor an RA-specific medication. The risk of incident RA was estimated using anage-adjusted Cox model that considers smoking status as a time-dependentvariable.

Results：Among 71 248 women, 371 incident RA caseswere confirmed. Ever-smokers not exposed to passive smoking had an increasedrisk of RA [1.38 (95% CI 1.10, 1.74)]. In never-smokers, passive smokingexposure during childhood was associated with a borderline increased risk of RAin the same range as active smoking in adults, with an hazard ratio (HR) of1.43 (95% CI 0.97, 2.11). Ever-smokers who also had childhood passive smokingexposure had a higher risk of RA than smokers not exposed during childhood [HR1.67 (95% CI 1.17, 2.39)], but without a significant difference (P = 0.30). RAbegan earlier in smokers exposed to childhood passive smoking.

Conclusion：This study confirms that active smoking isassociated with an increased risk of RA. It suggests for the first time thatpassive exposure to tobacco during childhood might also increase the risk of RAin future light smokers and probably non-smokers. Our results highlight theimportance of avoiding any tobacco environment in children, especially in thosewith a family history of RA.

引自:Raphaèle Seror， Julien Henry， Gaelle Gusto， Henri-Jean Aubin，Marie-ChristineBoutron-Ruault， Xavier Mariette . Passivesmoking in childhood increases the risk of developing rheumatoid arthritis.Rheumatology 2019; 58:1154–1162.