Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
Common Vaccinations among Adults and the Risk of Developing Rheumatoid Arthritis; Results from the Swedish EIRA Study.
Bengtsson2, Camilla, Kapetanovic1, Meliha, Kallberg2, Henrik, Sverdrup2, Berit, Nordmark3, Birgitta, Klareskog3, Lars, Alfredsson2, Lars
Institute for Clinical Sciences, Department of Rheumatology, Lund University, Lund, Sweden
Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
Rheumatology Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
Vaccinations are among the events frequently considered as inciting agents for rheumatoid arthritis (RA), but no sufficiently powered epidemiological studies have been published addressing whether vaccinations commonly used in industrialised societies constitute risk factors for RA1.
To investigate whether common vaccinations given to adults were associated with an increased risk of RA, and whether vaccinations have different impact on two subsets of RA, characterized by presence/absence of antibodies to citrullinated peptides (ACPA). In addition we examined potential interactions between vaccinations and smoking and between vaccinations and HLA-DRB1 SE alleles regarding risk of ACPA-positive RA.2
Data from the Swedish population-based EIRA (Epidemiological Investigation of Rheumatoid Arthritis) case-control study encompassing 1998 incident cases aged 1870 years and 2252 randomly selected controls, matched on age, sex and residency, was analysed. All cases were diagnosed by rheumatologists according to the ACR criteria of 1987. Those vaccinated within five years prior to disease onset were compared with those not vaccinated within five years before disease onset, by calculating odds ratios (OR) with 95% confidence interval (CI). Biological interaction, defined by departure from additivity of effects was evaluated between vaccination and smoking and between vaccination and HLA-DRB1 SE alleles.
In total, 31% of the cases and 31% of the controls had been vaccinated. Vaccinations did neither increase the risk of RA overall (OR=1.0 (95% CI 0.91.1) nor the risk of ACPA-positive or ACPA-negative disease. Furthermore, there was no association between any specific vaccine (influenza, tetanus, diphtheria, tick-borne encephalitis, hepatitis (A, B, C together), polio, pneumococcus) and the risk of RA. Finally, no interaction was found between any vaccination and smoking or between any vaccination and SE alleles regarding risk of ACPA-positive disease.
Our results indicate that immunological provocation with common vaccines given to adults in their present form is not a major risk factor for RA, at least not vaccines administered within five years before onset of disease. In addition, the results indicate that active immunisation does not increase the risk of RA in individuals with established risk factors, i.e smokers or those carrying HLA-DRB1 SE alleles. These findings should be implemented among clinicians and health care providers in order to encourage common vaccinations according to recommended vaccinations schedule for adults.
2.Klareskog, L, Stolt, P & Lundberg, K, et al. A new model for an etiology of RA: smoking may trigger HLA-DR (shared epitope)-restricted immune reactions to autoantigens modified by citrullination. Arthritis Rheum. 2006;54:38-46.
To cite this abstract, please use the following information:
Bengtsson, Camilla, Kapetanovic, Meliha, Kallberg, Henrik, Sverdrup, Berit, Nordmark, Birgitta, Klareskog, Lars, et al; Common Vaccinations among Adults and the Risk of Developing Rheumatoid Arthritis; Results from the Swedish EIRA Study. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :645