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.
Lower Body Mass Index Is Associated with an Increased Risk of Giant Cell Arteritis.
Jakobsson3, Karin, Jacobsson2, Lennart T. H., Warrington1, Kenneth J., Matteson1, Eric L., Liang5, Kimberly P., Melander4, Olle, Turesson3, Carl
There is limited data on predictors of giant cell arteritis (GCA). In a previous case-control study of women with GCA, a history of smoking, low body mass index (BMI) and several hormonal factors were associated with GCA. Smoking and a low level of formal education have been found to predict other chronic inflammatory disorders, including rheumatoid arthritis.
To examine potential risk factors of GCA in a nested case-control study based on two prospective health surveys.
We studied two population based health surveys performed in the same catchment area, the Preventive Medicine Program (PMP) and the Diet Cancer Study (DCS). In the PMP, 33346 subjects (22444 men and 10902 women) were included between 1974 and 1992, and in the DCS, 30447 subjects (12121 men and 18326 women), were included between 1991 and 1996. Information on medical history and life style factors was obtained using standard physical examinations and self-administered questionnaires. From this population, individuals who developed GCA after inclusion were identified by linking the PMP and DCS databases to the local patient administrative register and the national hospital discharge register. A structured review of the medical records of all identified cases was performed. Patients were classified according to the ACR criteria for GCA and the date of diagnosis was noted. Four controls for every confirmed case, matched for sex, year of birth and year of screening, who were alive and free of GCA when the index person was diagnosed with GCA, were selected from the PMP and DCS databases, respectively. For cases who had participated in both surveys, the screening closest preceding the diagnosis of GCA was used. The impact of potential predictors of GCA, including BMI, smoking, and other lifestyle factors, was examined in conditional logistic regression models.
Eighty-three patients (70 % women, 64 % biopsy positive, mean age at diagnosis 71 years) had a confirmed diagnosis of GCA after inclusion in the PMP or the DCS. The median time from screening to GCA diagnosis was 10.6 years (range 0.328.2). BMI at screening was lower in GCA cases than in matched controls (mean 24.3 vs 25.6 kg/m2). In logistic regression analysis, a higher BMI was associated with a significantly reduced risk of subsequent development of GCA [Odds ratio (OR) 0.91 per kg/m2; 95 % confidence interval (CI) 0.840.98]. Individuals who were overweight (BMI>25 kg/m2) had a lower risk for GCA (OR 0.39, 95 % CI 0.210.70) compared to those with a normal or low BMI. There was no significant association between current smoking at screening (OR 1.36; 95 % CI 0.772.57) or a history of early menopause (before age 46) (OR 1.76; 95 % CI 0.714.39) and GCA. Level of formal education and breast-feeding history did not predict GCA. In multivariate analysis, adjusted for smoking and level of formal education, the association between higher BMI and reduced risk of GCA remained significant (OR 0.91 per kg/m2; 95% CI 0.850.99)
In this study, subsequent development of GCA was predicted by a lower BMI at baseline. Potential explanations include an effect of adipose tissue on hormonal pathways regulating inflammation in the context of GCA.
To cite this abstract, please use the following information:
Jakobsson, Karin, Jacobsson, Lennart T. H., Warrington, Kenneth J., Matteson, Eric L., Liang, Kimberly P., Melander, Olle, et al; Lower Body Mass Index Is Associated with an Increased Risk of Giant Cell Arteritis. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :774