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| Allan Gelber, M.D., M.P.H
Abstract #1938 Lifestyle Factors Associated with Development of Rheumatoid Arthritis: Results from the Black Womens Health Study. The investigators examined the relationship of several lifestyle factors, specifically coffee, tea and alcohol consumption, as well as smoking, in the Black Womens Health Study. This is a prospective cohort study of 64,000 black women that was initiated in 1995. RA was defined on the basis of a physician diagnosis of RA or use of appropriate DMARD therapy. Seventy-one women were classified as having incident RA. Controls were matched to these cases, with a 10:1 ratio, to determine the risk associated with the above lifestyle factors. The investigators found that incident RA cases were more likely, at baseline, to have been current smokers, current alcohol drinkers, and have drunk at least one cup per day of decaffeinated coffee. In the multivariate analysis, smoking was associated with greater than a two-fold greater risk of developing rheumatoid arthritis. Of note, both tea and decaffeinated coffee consumption were also associated with a two-fold increased risk of developing rheumatoid arthritis. The association with alcohol consumption was no longer statistically significant. Editorial Comments: While much prior work has addressed risk factors associated with the incidence and prevalence of rheumatoid arthritis, relatively little prior study has addressed such factors in African American women. The present study addresses this population. Moreover, it defines a potential new risk factor in the pathogenesis of RA. These data suggest that decaffeinated coffee and tea drinking, as well as smoking, represent risk factors for the development of rheumatoid arthritis. The potential biological link between these putative risk factors and incidence of RA is not, however, addressed in the Abstract. Abstract #1934 Coffee, Tea, and Caffeine Consumption and Risk of Rheumatoid Arthritis: Results from the Iowa Womens Health Study. The Iowa Womens Health Study was initiated in 1986. At its inception, the cohort compromised 31,336 women aged 55-69 years, without a prior history of rheumatoid arthritis. The investigators examined the association of coffee, tea, and caffeine consumption to the development of rheumatoid arthritis in this population. During 334,463 years of follow-up, 158 cases of incident rheumatoid arthritis were identified. Cases of rheumatoid arthritis were validated against medical records. Among these beverages, those women consuming > 4 cups of decaffeinated coffee per day experienced a greater than two-fold (relative risk 2.58) greater risk of developing rheumatoid arthritis, whereas those women consuming > 3 cups of tea per day had a 60% decreased risk (relative risk 0.39) of incidence RA. In contrast, consumption of caffeinated coffee was not associated with increased risk of incident RA. Adjustment for age, smoking, menopausal age, marital status, and use of hormone replacement therapy, did not alter these results. Editorial Comments: These findings suggest that decaffeinated coffee is associated with an excess risk of developing rheumatoid arthritis, whereas tea is associated with a protective effect. The findings are strengthened by the observed dose-response effect, whereby highest levels of decaffeinated coffee and tea are associated with a greater deleterious and beneficial profile, respectively. No mention is made in the Abstract, as to whether the tea associated with the observed reduced risk of incident RA constituted a caffeinated or decaffeinated tea beverage. Abstract #1276 Trends in Incidence and Mortality in Rheumatoid Arthritis in Rochester, MN over a 40-Year Period. The investigators sought to determine if changes in the epidemiology of rheumatoid arthritis had occurred over time. To address this issue, they studied an inception cohort of rheumatoid arthritis among residents of Rochester MN. These persons first fulfilled the American College of Rheumatology criteria for rheumatoid arthritis between 1955 through 1994. The study was concluded on January 1, 2000. Incidence rates were estimated in relation to the US 1990 white population. 609 cases of incident rheumatoid arthritis were noted over this time period. 73% occurred in women. The mean at disease incidence was 58 years. The age- and ex- adjusted annual incidence of rheumatoid arthritis was 44.8 per 100,000 population. Of note, the incidence of rheumatoid arthritis fell over this forty year period, from 61.1/100,000 in 19955-64 to 32.7/100,000 in 1985-94. There was evidence of cyclical trends over time. Birth cohort analysis demonstrated diminishing incidence rates through successive birth cohorts, following a peak in the 1880-1890 cohort. Incidence increased with age, until age 85. Incidence rates also peaked at an earlier age in women than in men. Survival among these patients with rheumatoid arthritis was significantly lower than in the general population. No change in survival, among the successful birth cohorts of RA patients, was noted over time. Editorial Comments: The fact that the incidence of rheumatoid arthritis has in fact changed over time, in a relatively genetically stable population, suggests that a change in an environmental factor(s) may be playing an important role in changing patterns of RA incidence over this forty year period of observation. That there has been no improvement over the observed time period in survival is disconcerting. Abstract #1277 Prevalence of Cardiovascular Disease Risk Factors Among U.S. Adults with Osteoarthritis and Rheumatoid Arthritis.
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