Reumatología Clínica

Reumatología Clínica

Volume 8, Issue 6, November–December 2012, Pages 342-350
Reumatología Clínica

Revisión
Tabaco y otros factores ambientales en la artritis reumatoideTobacco and other environmental risk factors in rheumatoid arthritis

https://doi.org/10.1016/j.reuma.2012.02.011Get rights and content

Resumen

Existen distintos factores ambientales implicados en la patogenia de la artritis reumatoide, aunque es el tabaco el factor más ampliamente estudiado y reconocido. El tabaquismo está asociado a un incremento del riesgo de artritis reumatoide seropositiva (FR y/o ACPA). Además estudios recientes ponen de manifiesto que el consumo de tabaco puede influir en la expresión clínica de la enfermedad, determinar un curso evolutivo más grave y una mayor destrucción articular, aunque no todos los estudios son concordantes. Datos recientes sugieren que la respuesta al tratamiento antirreumático sería peor en los enfermos fumadores. En el presente artículo se revisan los distintos factores ambientales que han sido implicados en la AR, con especial énfasis en el tabaquismo.

Abstract

Many environmental factors have been associated with an increased risk of developing Rheumatoid Arthritis (RA), but so far smoking is the only environmental risk factor that has been extensively studied and widely accepted. Smoking is associated with an increased risk of developing seropositive RA (RF and/or ACPA). Recent studies show that tobacco smoking can influence disease phenotype, with the development of more aggressive disease and greater joint damage; but other studies show contradictory results. Recent data suggests that response to antirheumatic therapy in RA is worse in smokers. In this article we review different environmental factors that have been associated with an increased risk of developing RA, with a special interest in tobacco smoking.

Section snippets

Introducción

La artritis reumatoide (AR) es la artropatía inflamatoria crónica más frecuente, afecta aproximadamente el 0,5%-1% de la población general y causa una progresiva destrucción articular, discapacidad y disminución de la expectativa de vida. La etiología de la AR es desconocida y su patogenia solo parcialmente conocida al día de hoy. En los últimos años se han estudiado e identificado múltiples factores de riesgo para su desarrollo. Sabemos que intervienen factores genéticos y ambientales y que la

Tabaco e inmunidad

El consumo de tabaco afecta a múltiples órganos, como el sistema respiratorio y cardiovascular, pero también afecta al sistema inmune produciendo una respuesta inflamatoria. Se ha observado que el tabaco afecta la respuesta inmune tanto celular como humoral y podría tener tanto efectos pro-inflamatorios como inmunosupresores a través de mecanismos diversos59. Por un lado se ha descrito que puede incrementar la respuesta inflamatoria, observándose en fumadores un aumento del fibrinógeno sérico,

Conclusiones

Se han estudiado múltiples factores ambientales de predisposición a la AR, aunque no cabe duda que el tabaco se constituye como el factor más ampliamente estudiado y del que existen mayores evidencias científicas sobre su implicación en esta enfermedad. El tabaquismo podría justificar hasta un tercio de los casos de AR seropositivas, ya que el incremento de riesgo asociado al tabaco, parece confinarse básicamente a las AR con autoanticuerpos positivos (FR y/o ACPAs). El efecto del tabaco sobre

Responsabilidades éticas

Protección de personas y animales. Los autores declaran que para esta investigación no se han realizado experimentos en seres humanos ni en animales.

Confidencialidad de los datos. Los autores declaran que en este artículo no aparecen datos de pacientes.Derecho a la privacidad y consentimiento informado. Los autores declaran que en este artículo no aparecen datos de pacientes.

Conflicto de intereses

Los autores declaran no tener ningún conflicto de intereses.

Bibliografía (123)

  • A.J. MacGregor et al.

    Characterizing the quantitative genetic contribution to rheumatoid arthritis using data from twins

    Arthritis Rheum

    (2000)
  • M.F. Seldin et al.

    The genetics revolution and the assault on rheumatoid arthritis

    Arthritis Rheum

    (1999)
  • S. John et al.

    Linkage of cytokine genes to rheumatoid arthritis Evidence of genetic heterogeneity

    Ann Rheum Dis

    (1998)
  • D.L. Mattey et al.

    Smoking and HLA-DR shared epitope alleles in rheumatoid arthritis: comment on the article by Padyukov et al

    Arthritis Rheum

    (2005)
  • E.W. Karlson et al.

    Gene-environment interaction between HLA-DRB1 shared epitope and heavy cigarette smoking in predicting incident rheumatoid arthritis

    Ann Rheum Dis

    (2010)
  • R.D. Oliveira et al.

    Share epitope, citrullinated cyclic peptide antibodies and smoking in Brazilian rheumatoid arthritis patients

    Clin Rev Allergy Immunol

    (2008)
  • L. Padyukov et al.

    A gene-environment interaction between smoking and shared epitope genes in HLA-DR provides a high risk of seropositive rheumatoid arthritis

    Arthritis Rheum

    (2004)
  • R. Sanmarti et al.

    Prognostic factors of radiographic progression in early rheumatoid arthritis: a two year prospective study after a structured therapeutic strategy using DMARDs and very low doses of glucocorticoids

    Clin Rheumatol

    (2007)
  • F.C. Hall et al.

    Influence of the HLA-DRB1 locus on susceptibility and severity in rheumatoid arthritis

    Qjm

    (1996)
  • C. Turesson et al.

    The impact of HLA-DRB1 genes on extra-articular disease manifestations in rheumatoid arthritis

    Arthritis Res Ther

    (2005)
  • F. Cornelis et al.

    New susceptibility locus for rheumatoid arthritis suggested by a genome-wide linkage study

    Proc Natl Acad Sci U S A

    (1998)
  • D. Jawaheer et al.

    Rheumatoid arthritis The genetic components

    Rheum Dis Clin North Am

    (2002)
  • A.T. Lee et al.

    The PTPN22 R620W polymorphism associates with RF positive rheumatoid arthritis in a dose-dependent manner but not with HLA-SE status

    Genes Immun

    (2005)
  • E.F. Remmers et al.

    STAT4 and the risk of rheumatoid arthritis and systemic lupus erythematosus

    N Engl J Med

    (2007)
  • G. Orozco et al.

    Association of STAT4 with rheumatoid arthritis: a replication study in three European populations

    Arthritis Rheum

    (2008)
  • R.M. Plenge

    Recent progress in rheumatoid arthritis genetics: one step towards improved patient care

    Curr Opin Rheumatol

    (2009)
  • F.A. Kurreeman et al.

    A candidate gene approach identifies the TRAF1/C5 region as a risk factor for rheumatoid arthritis

    PLoS Med

    (2007)
  • J.L. Nelson et al.

    Maternal-fetal disparity in HLA class II alloantigens and the pregnancy-induced amelioration of rheumatoid arthritis

    N Engl J Med

    (1993)
  • C. Jorgensen et al.

    Oral contraception, parity, breast feeding, and severity of rheumatoid arthritis

    Ann Rheum Dis

    (1996)
  • E. Berglin et al.

    Influence of female hormonal factors, in relation to autoantibodies and genetic markers, on the development of rheumatoid arthritis in northern Sweden: a case-control study

    Scand J Rheumatol

    (2010)
  • M.F. Doran et al.

    The effect of oral contraceptives and estrogen replacement therapy on the risk of rheumatoid arthritis: a population based study

    J Rheumatol

    (2004)
  • M. Pedersen et al.

    Environmental risk factors differ between rheumatoid arthritis with and without auto-antibodies against cyclic citrullinated peptides

    Arthritis Res Ther

    (2006)
  • E.W. Karlson et al.

    Do breast-feeding and other reproductive factors influence future risk of rheumatoid arthritis? Results from the Nurses’ Health Study

    Arthritis Rheum

    (2004)
  • M. Pikwer et al.

    Breast feeding, but not use of oral contraceptives, is associated with a reduced risk of rheumatoid arthritis

    Ann Rheum Dis

    (2009)
  • M. Pladevall-Vila et al.

    Controversy of oral contraceptives and risk of rheumatoid arthritis: meta-analysis of conflicting studies and review of conflicting meta-analyses with special emphasis on analysis of heterogeneity

    Am J Epidemiol

    (1996)
  • M. Pikwer et al.

    Early menopause is an independent predictor of rheumatoid arthritis

    Ann Rheum Dis

    (2011)
  • R. Heikkila et al.

    Serum androgen-anabolic hormones and the risk of rheumatoid arthritis

    Ann Rheum Dis

    (1998)
  • C. Bengtsson et al.

    Socioeconomic status and the risk of developing rheumatoid arthritis: results from the Swedish EIRA study

    Ann Rheum Dis

    (2005)
  • M. Pedersen et al.

    Socioeconomic status and risk of rheumatoid arthritis: a Danish case-control study

    J Rheumatol

    (2006)
  • U. Bergstrom et al.

    Pulmonary dysfunction, smoking, socioeconomic status and the risk of developing rheumatoid arthritis

    Rheumatology (Oxford)

    (2011)
  • M. Rosell et al.

    Dietary fish and fish oil and the risk of rheumatoid arthritis

    Epidemiology

    (2009)
  • D.J. Pattison et al.

    The role of diet in susceptibility to rheumatoid arthritis: a systematic review

    J Rheumatol

    (2004)
  • E. Benito-Garcia et al.

    Protein, iron, and meat consumption and risk for rheumatoid arthritis: a prospective cohort study

    Arthritis Res Ther

    (2007)
  • M.M. Nielen et al.

    Vitamin D deficiency does not increase the risk of rheumatoid arthritis: comment on the article by Merlino et al

    Arthritis Rheum

    (2006)
  • M.F. Holick

    Vitamin D deficiency

    N Engl J Med

    (2007)
  • L.A. Merlino et al.

    Vitamin D intake is inversely associated with rheumatoid arthritis: results from the Iowa Women's Health Study

    Arthritis Rheum

    (2004)
  • S. Patel et al.

    Association between serum vitamin D metabolite levels and disease activity in patients with early inflammatory polyarthritis

    Arthritis Rheum

    (2007)
  • U.J. Haque et al.

    Relationships among vitamin D, disease activity, pain and disability in rheumatoid arthritis

    Clin Exp Rheumatol

    (2010)
  • G.S. Kerr et al.

    Prevalence of vitamin D insufficiency/deficiency in rheumatoid arthritis and associations with disease severity and activity

    J Rheumatol

    (2011)
  • H. Kallberg et al.

    Alcohol consumption is associated with decreased risk of rheumatoid arthritis: results from two Scandinavian case-control studies

    Ann Rheum Dis

    (2009)
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