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BMJ Open

Title:		"Polycyclic aromatic hydrocarbons and risk of rheumatoid arthritis: a cross-sectional analysis of the National Health and Nutrition Examination Survey, 2007-2016"
Author(s):		Beidelschies M; Lopez R; Pizzorno J; Le P; Rothberg MB; Husni ME; D'Adamo C;
Address:		"Center for Functional Medicine, Cleveland Clinic, Cleveland, Ohio, USA functionalmedicine@ccf.org. Department of Surgery, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, USA. Naturopathic Medicine Department, Bastyr University, Kenmore, Washington, USA. Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio, USA. Department of Rheumatologic and Immunologic Disease, Cleveland Clinic, Cleveland, Ohio, USA. Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA. Medical Education Department, The Institute for Functional Medicine, Federal Way, Washington, USA"
Journal Title:		BMJ Open
Year:		2023
Volume:		20230509
Issue:		5
Page Number:		e071514 -
DOI:		10.1136/bmjopen-2022-071514
ISSN/ISBN:		2044-6055 (Electronic) 2044-6055 (Linking)
Abstract:		"OBJECTIVE: While there are several well-established environmental risk factors for rheumatoid arthritis (RA), a paucity of evidence exists linking environmental toxicants with RA prevalence. We aimed to examine the associations between various environmental toxicants and RA among adults in the U.S. general population while adjusting for non-heritable risk factors. DESIGN: Cross-sectional study. SETTING: National Health and Nutrition Examination Survey conducted from 2007 to 2016. PARTICIPANTS: The study included 21 987 adult participants (no RA: 20 569; RA: 1418). Participants were excluded (n=7214) if they did not answer questions related to self-reporting of RA, had another or unknown type of arthritis, or did not have interview or biospecimen data. PRIMARY AND SECONDARY OUTCOME MEASURES: Association between individual toxicants and body burden scores for polycyclic aromatic hydrocarbons (PAH), phthalates and plasticisers (PHTHTEs) metabolites or volatile organic compounds (VOCs) and participant self-reported RA based on multivariable logistic regression models while adjusting for age, sex, urine creatinine, body mass index, smoking, race, education, family poverty income ratio, any vigorous or moderate activity and dietary fibre. RESULTS: While increased prevalence of RA was observed in participants with the highest quartile of various individual PAHs, only 1-hydroxynaphthalene (OR: 1.8 (1.1 to 3.1); p=0.020) remained associated in a fully adjusted model. PAH body burden was found to be associated with RA (Q4 vs Q1, OR: 2.2 (1.09 to 4.2); p=0.028) in a fully adjusted model. Interestingly, after accounting for PAH body burden, smoking was not associated with RA (OR: 1.4 (0.89 to 2.3); p=0.13). A mediation analysis demonstrated that PAH body burden accounted for 90% of the total effect of smoking on RA. PHTHTE and VOC metabolites were not associated with RA in fully adjusted models. CONCLUSIONS AND RELEVANCE: PAHs are associated with RA prevalence, mediate the majority of the effects of smoking on RA, and are associated with RA independent of smoking status"
Keywords:		"Adult Humans Cross-Sectional Studies *Smoking Nutrition Surveys *Arthritis, Rheumatoid/epidemiology Tobacco Smoking Hazardous Substances Epidemiology Public health Rheumatology Toxicology;"
Notes:		"MedlineBeidelschies, Michelle Lopez, Rocio Pizzorno, Joseph Le, Phuc Rothberg, Michael B Husni, M E D'Adamo, Christopher eng England 2023/05/10 BMJ Open. 2023 May 9; 13(5):e071514. doi: 10.1136/bmjopen-2022-071514"