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Onell C, Skillgate E, Melin A, Källberg H, Waldén M, Edlund K, Hägglund M, Côté P, Asker M. Dietary habits in adolescent male and female handball players: the Swedish Handball Cohort. BMJ Open Sport Exerc Med 2023; 9:e001679. [PMID: 38143719 PMCID: PMC10749036 DOI: 10.1136/bmjsem-2023-001679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2023] [Indexed: 12/26/2023] Open
Abstract
Objectives This cross-sectional study aimed to describe dietary habits in Swedish adolescent handball players and differences with respect to sex and school grade. Methods Participants in the Swedish Handball Cohort answered a web-survey assessing adherence to sports nutrition recommendations for meal frequency and meal timing, and the Nordic Nutrition Recommendations (NNR) for fruits/vegetables and fish/seafood, food exclusions and use of dietary supplements. Differences with respect to sex and school grade were estimated with generalised linear models, generating prevalence ratios (PR) with 95% CIs. Results A total of 1040 participants (16.6±0.9 years, 51% males) were included. Overall, 70% and 90%, respectively, met recommendations for meal frequency and meal timing, whereas adherence to recommended carbohydrate intake during training/game was met by 17%. Adherence to the NNR for fruits/vegetables and fish/seafood was met by 16% and 37%, respectively. Twenty-eight per cent reported using dietary supplements. Females reported lower frequency of meals, especially morning snacks (-0.6 days/week (95% CI -0.3 to -0.9)) and evening snacks (-0.8 days/week (95% CI -0.5 to -1.1)), higher prevalence of exclusions due to intolerances (PR 1.66 (95% CI 1.31 to 2.01)) and other reasons (PR 1.36 (95% CI 1.08 to 1.64)), higher adherence to the NNR for fruits/vegetables (PR 2.30 (95% CI 1.98 to 2.62)) and use of micronutrient supplements (PR 1.72 (95% CI 1.43 to 2.00)) compared with males. Only small differences were observed between school grades. Conclusions Swedish adolescent handball players' dietary habits are fairly in accordance with sports nutrition recommendations but not the NNR. Females appear to display more restrictive habits than males.
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Affiliation(s)
- Clara Onell
- Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden
| | - Eva Skillgate
- Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden
- Unit for Intervention and Implementation Research in Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anna Melin
- Department of Sport Science, Linnaeus University, Växjö/Kalmar, Sweden
| | - Henrik Källberg
- Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden
- Department of Public Health, Analysis and Data Management, The Public Health Agency of Sweden, Solna, Sweden
| | - Markus Waldén
- Unit of Public Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Capio Ortho Center Skåne, Malmö, Sweden
| | - Klara Edlund
- Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Martin Hägglund
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Pierre Côté
- Institute for Disability and Rehabilitation Research, Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada
| | - Martin Asker
- Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden
- Naprapathögskolan - Scandinavian College of Naprapathic Manual Medicine, Stockholm, Sweden
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Schindele AC, Källberg H, Areskoug Josefsson K, Lindroth M. Perceived knowledge gained from school-based sexuality education - results from a national population-based survey among young people in Sweden. Sex Health 2023; 20:566-576. [PMID: 37925747 DOI: 10.1071/sh23093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 10/13/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND School-based sexuality education is a core component of securing young people's right to attain health equity regarding sexual and reproductive health and rights. This paper aims to explore how perceived knowledge (sufficient or insufficient) of taking care of one's sexual health is associated with knowledge gained from school-based sexuality education and social determinants. METHODS The data material is drawn from a population-based survey conducted in Sweden in 2015. The survey had 7755 respondents and a response rate of 26%. To explore the aim descriptive statistics and logistic regression models were used. RESULTS Our results show that perceived insufficient knowledge from school-based sexuality education was associated with higher odds of reporting not being able to take care of one's sexual health. The highest significant excess risk for insufficient knowledge was found among young people from sexual minorities. CONCLUSIONS Young people in Sweden do not have equal abilities to receive knowledge needed to take care of their sexual health and thus attain sexual health literacy. There is an unequal distribution of perceived knowledge, and LGBTQI+ youth particularly face barriers in using school-based sexuality education as a resource for sexual health literacy.
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Affiliation(s)
- Anna ChuChu Schindele
- Faculty of Health and Society, Institution for Social Work, Centre for Sexology and Sexuality Studies, Malmö University, Malmö, Sweden; and Unit for Sexual Health and HIV Prevention, Department of Communicable Disease Control and Health Protection, The Public Health Agency of Sweden, Stockholm, Sweden
| | - Henrik Källberg
- Unit for Analysis, Department of Public Health Analysis and Data Management, The Public Health Agency of Sweden, Stockholm, Sweden
| | - Kristina Areskoug Josefsson
- Department of Health Sciences, University West, Trollhättan, Sweden; and Department of Behavioural Science, Oslo Metropolitan University, Oslo, Norway
| | - Malin Lindroth
- Faculty of Health and Society, Institution for Social Work, Centre for Sexology and Sexuality Studies, Malmö University, Malmö, Sweden; and Department of Behavioural Science, Oslo Metropolitan University, Oslo, Norway
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Johansson F, Côté P, Onell C, Källberg H, Sundberg T, Edlund K, Skillgate E. Strengths of associations between depressive symptoms and loneliness, perfectionistic concerns, risky alcohol use and physical activity across levels of sleep quality in Swedish university students: A cross-sectional study. J Sleep Res 2023; 32:e13745. [PMID: 36217878 DOI: 10.1111/jsr.13745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/22/2022] [Accepted: 09/16/2022] [Indexed: 11/30/2022]
Abstract
Previous research shows that sleep quality may interact with some other predictors of depression, such that poor sleep could strengthen the association between these factors and depression. We aimed to determine the presence of statistical interactions between sleep quality and loneliness, risky alcohol use, perfectionistic concerns and/or physical inactivity in relation to depressive symptoms. Further, we aimed to describe the functional form of the statistical interactions and associations. We used a cross-sectional design and included 4262 Swedish university students. All measures were self-reported, sleep quality was measured with the Pittsburgh Sleep Quality Index, and depressive symptoms with the short-form Depression, Anxiety and Stress Scale. Regression models of increasing complexity (linear and non-linear, with and without interactions) were compared to determine the presence of associations and statistical interactions, and to explore the best functional form for these associations and interactions. Out-of-sample R2 from repeated cross-validation was used to select the final models. We found that sleep quality was associated with depressive symptoms in all final models. Sleep quality showed a linear interaction with perfectionistic concerns in relation to depressive symptoms, such that perfectionistic concerns were more strongly associated with depressive symptoms when sleep quality was poor. Loneliness, risky alcohol use and physical inactivity were non-linearly associated with depressive symptoms but did not interact with sleep quality. We concluded that out of the four examined variables, only perfectionistic concerns interacted with sleep quality in relation to depressive symptoms. This interaction was weak and explained little of the overall variance in depressive symptoms.
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Affiliation(s)
- Fred Johansson
- Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden.,Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Pierre Côté
- Institute for Disability and Rehabilitation Research, Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Clara Onell
- Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden
| | - Henrik Källberg
- Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden
| | - Tobias Sundberg
- Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden.,Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Klara Edlund
- Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden.,Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Eva Skillgate
- Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden.,Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Fältström A, Skillgate E, Weiss N, Källberg H, Lyberg V, Waldén M, Hägglund M, Asker M, Tranaeus U. Lifestyle characteristics in adolescent female football players: data from the Karolinska football Injury Cohort. BMC Sports Sci Med Rehabil 2022; 14:212. [PMID: 36517880 PMCID: PMC9753279 DOI: 10.1186/s13102-022-00603-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Normative values of lifestyle characteristics in adolescent female football players may be used by clinicians and coaches to take actions because the potential important for well-being, performance on the pitch, and risk of injury. The aim was to report descriptive characteristics of lifestyle factors in adolescent female football players and potential changes over 1 year. METHODS We included 419 adolescent competitive female football players from 12 clubs and 27 teams (age 14 ± 1 years, range 12-17 years) and 286 were followed over 1 year. The players completed an extensive questionnaire regarding demographics, football-related factors, and lifestyle factors including tobacco consumption, alcohol use, medicine intake, eating and sleeping habits, well-being, stress, coping, and passion. Baseline data are presented for the total cohort and separately for 4 age groups (12, 13, 14, and 15-17 years). RESULTS 12% skipped breakfast, 8% skipped lunch and 11% used protein supplements several days per week. 16% slept less than 8 h/night, 8% had impaired sleep with daytime consequences, and 22% stated that they were tired in daily activities several days per week. 32% experienced stress some or most days/week and 24% were classified as having psychological distress. Medicine intake (23% vs. 34%), skipping breakfast or lunch several days per week (10% vs. 47% and 20 vs. 33%), tiredness (20% vs. 27%), stress (26% vs. 40%), and psychological distress (27% vs. 37%) increased significantly (P = 0.031 to < 0.001) at the 1-year follow-up. CONCLUSION Many adolescent female football players skip breakfast and lunch, have insufficient sleep, experience stress and are classified as having psychological distress. These factors increased over 1 year.
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Affiliation(s)
- Anne Fältström
- grid.445308.e0000 0004 0460 3941Department of Health Promotion Science, Musculoskeletal & Sports Injury Epidemiology Center, Sophiahemmet University, Stockholm, Sweden ,grid.5640.70000 0001 2162 9922Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden ,grid.413253.2Region Jönköping County, Rehabilitation Centre, Ryhov County Hospital, Jönköping, Sweden
| | - Eva Skillgate
- grid.445308.e0000 0004 0460 3941Department of Health Promotion Science, Musculoskeletal & Sports Injury Epidemiology Center, Sophiahemmet University, Stockholm, Sweden ,grid.4714.60000 0004 1937 0626Unit of Intervention and Implementation for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Nathan Weiss
- grid.445308.e0000 0004 0460 3941Department of Health Promotion Science, Musculoskeletal & Sports Injury Epidemiology Center, Sophiahemmet University, Stockholm, Sweden ,grid.4714.60000 0004 1937 0626Unit of Intervention and Implementation for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Källberg
- grid.445308.e0000 0004 0460 3941Department of Health Promotion Science, Musculoskeletal & Sports Injury Epidemiology Center, Sophiahemmet University, Stockholm, Sweden ,grid.419734.c0000 0000 9580 3113Unit of analysis, Department of Public Health, Analysis and Data Management, Public Health Agency of Sweden, Stockholm, Sweden
| | - Victor Lyberg
- grid.445308.e0000 0004 0460 3941Department of Health Promotion Science, Musculoskeletal & Sports Injury Epidemiology Center, Sophiahemmet University, Stockholm, Sweden
| | - Markus Waldén
- Unit of Public Health, Department of Health, Medicine and Caring Sciences, Linköping, Sweden ,GHP Ortho Center Skåne, Malmö, Sweden
| | - Martin Hägglund
- grid.5640.70000 0001 2162 9922Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden ,grid.5640.70000 0001 2162 9922Sport Without Injury ProgrammE (SWIPE), Linköping University, Linköping, Sweden
| | - Martin Asker
- grid.445308.e0000 0004 0460 3941Department of Health Promotion Science, Musculoskeletal & Sports Injury Epidemiology Center, Sophiahemmet University, Stockholm, Sweden ,grid.4714.60000 0004 1937 0626Unit of Intervention and Implementation for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden ,Naprapathögskolan, Scandinavian College of Naprapathic Manual Medicine, Stockholm, Sweden
| | - Ulrika Tranaeus
- grid.4714.60000 0004 1937 0626Unit of Intervention and Implementation for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden ,grid.416784.80000 0001 0694 3737Department of Physiology, Nutrition, Biomechanic, Sport Performance & Exercise Research & Innovation Center - Stockholm, SPERIC-S, The Swedish School of Sport and Health Sciences, Stockholm, Sweden
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5
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Johansson F, Côté P, Onell C, Källberg H, Sundberg T, Edlund K, Skillgate E. Strengths of Associations Between Potential Risk Factors and Depressive Symptoms Across Levels of Sleep Quality in University Students: A Cross-sectional Study. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Asker M, Hägglund M, Waldén M, Källberg H, Skillgate E. The Effect of Shoulder and Knee Exercise Programmes on the Risk of Shoulder and Knee Injuries in Adolescent Elite Handball Players: A Three-Armed Cluster Randomised Controlled Trial. Sports Med - Open 2022; 8:91. [PMID: 35834139 PMCID: PMC9283550 DOI: 10.1186/s40798-022-00478-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/13/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Background
The risk of injury in adolescent handball is high, and shoulder and knee injuries are among the most frequent and burdensome. The Swedish Knee Control programme reduced the risk of anterior cruciate ligament injuries in female youth football players and traumatic knee injuries in male and female youth floorball players. However, to date, Knee Control has not been evaluated in an elite youth sport setting. The literature on the prevention of shoulder injuries in sport is scarce, and there are to our knowledge no previous studies evaluating the preventative efficacy of injury prevention exercise programmes (IPEPs) on shoulder injuries in adolescent handball players.
Objectives
To study the preventive efficacy of IPEPs on shoulder and knee injuries in adolescent elite handball players.
Methods
Eighteen Swedish handball-profiled secondary schools (clusters) with players aged 15–19 years, 54% males were randomised into either the Shoulder Group or Knee Group (interventions) or a Control Group. Players in the Shoulder Group were instructed to perform the Shoulder Control programme, and players in the Knee Group to perform the Knee Control programme, three times per week during May 2018 to May 2019. Control Group players continued their usual training. Outcomes were shoulder and knee injuries defined by the Oslo Sports Trauma Research Center Overuse Injury Questionnaire. Intention-to-treat analyses were performed using Cox regression models with hazard rate ratios (HRRs) with corresponding 95% confidence intervals (CI).
Results
Six clusters (199 players) in the Shoulder Group, six clusters (216 players) in the Knee Group and six clusters (212 players) in the Control Group were included. There were 100 shoulder injuries and 156 knee injuries. The Shoulder Group had a 56% lower shoulder injury rate, HRR 0.44 (95% CI 0.29 to 0.68), and the Knee Group had a 31% lower knee injury rate, HRR 0.69 (95% CI 0.49 to 0.97) than the Control Group. The absolute risk reduction was 11% and 8%, and the number needed to treat was 9 and 13, respectively.
Conclusions
Adolescent elite handball players who performed the Shoulder Control and the Knee Control programmes had a lower risk of shoulder and knee injuries, respectively, than players who continued their usual training. Further research on how these two programmes can be combined to reduce knee and shoulder injuries in a time effective way is warranted.
Trial registration ISRCTN15946352.
Key points
The burden of knee and shoulder injuries in handball is high.
The Shoulder Control programme reduces the risk and overall burden of shoulder injuries in adolescent elite handball players.
The Knee Control programme reduces the risk and overall burden of knee injuries in adolescent elite handball players.
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Fältström A, Skillgate E, Tranaeus U, Weiss N, Källberg H, Lyberg V, Nomme M, Thome N, Omsland T, Pedersen E, Hägglund M, Waldén M, Asker M. Normative values and changes in range of motion, strength, and functional performance over 1 year in adolescent female football players: Data from 418 players in the Karolinska football Injury Cohort study. Phys Ther Sport 2022; 58:106-116. [DOI: 10.1016/j.ptsp.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/03/2022] [Accepted: 10/04/2022] [Indexed: 11/28/2022]
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8
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Larsson K, Onell C, Edlund K, Källberg H, Holm LW, Sundberg T, Skillgate E. Lifestyle behaviors in Swedish university students before and during the first six months of the COVID-19 pandemic: a cohort study. BMC Public Health 2022; 22:1207. [PMID: 35710368 PMCID: PMC9202972 DOI: 10.1186/s12889-022-13553-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/31/2022] [Indexed: 11/21/2022] Open
Abstract
Background Changes in Swedish university students’ lifestyle behaviors during the COVID-19 pandemic are unknown. This study aimed to assess physical activity, sitting time, meal frequency and risk substance use (alcohol, tobacco, and illicit use of drugs) in Swedish university students before and during the first six months of the COVID-19 pandemic, for all and stratified by age and sex. Methods Data were obtained from the Sustainable University Life cohort study in which web-based surveys were sent to university students repeatedly for one year. Baseline assessment (before the pandemic) was between August 2019-March 2020, follow-up 1 (FU1) between March-June 2020, and follow-up 2 (FU2) between June–September 2020. Participants reported weekly minutes of physical activity, daily sitting hours, meal frequency by weekly intake of different meals, and motivation for eating irregularly, if so. Also, harmful use of alcohol, tobacco and illicit drugs was assessed. Population means and differences with 95% confidence intervals (95% CI) in lifestyle behaviors between time points were calculated with Generalized Estimating Equations. Results 1877 students (73% women, mean age 26.5 years) answered the baseline survey. Weekly exercise decreased by -5.7 min (95% CI: -10.0, -1.5) and -7.7 min (95% CI: -12.6, -2.8) between baseline and FU1 and FU2, respectively. Weekly daily activities increased by 5.6 min (95% CI: 0.3, 11.7) and 14.2 min (95% CI: 7.9, 20.5) between baseline and FU1 and FU2. Daily sitting time decreased by -1.4 h (95% CI: -1.7, -1.2) between baseline and FU2. Breakfast intake increased by 0.2 days per week (95% CI: 0.1, 0.3) between baseline and FU2. Lunch intake decreased by -0.2 days per week (95% CI: -0.2, -0.1) between baseline and FU1 and by -0.2 days per week (95% CI: -0.3, -0.0) between baseline and FU2. Dinner intake decreased by -0.1 days per week (95% CI: -0.2, -0.0) between baseline and both FU1 and FU2. Only minor differences in risk substance use were observed. Similar changes were observed in analyses stratified by age and sex. Conclusions Lifestyle behaviors in Swedish university students slightly improved during the first six months of the COVID-19 pandemic compared to before. Trial registration ClinicalTrials.gov, NCT04465435. 10/07/2020. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13553-7.
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Affiliation(s)
- Kristina Larsson
- Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden
| | - Clara Onell
- Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden.
| | - Klara Edlund
- Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden.,Unit of Intervention and Implementation Research On Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Källberg
- Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden
| | - Lena W Holm
- Unit of Intervention and Implementation Research On Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Tobias Sundberg
- Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden
| | - Eva Skillgate
- Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden.,Unit of Intervention and Implementation Research On Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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9
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Aronsson B, Appelqvist E, Jämtberg K, Källberg H, Olin P, Storsaeter J. Long-term follow-up of the effectiveness of one whole-cell and two acellular pertussis vaccines based on a randomised controlled vaccine trial in Sweden. Acta Paediatr 2022; 111:1052-1053. [PMID: 34773298 DOI: 10.1111/apa.16184] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/29/2021] [Accepted: 11/11/2021] [Indexed: 11/29/2022]
Abstract
Sweden discontinued routine childhood vaccination against pertussis between 1979 and 1995. Meanwhile, various efficacy trials were performed in Sweden and elsewhere [1]. The larger of those trials was Stockholm Trial II, which included the whole country of Sweden except for the Gothenburg region.
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10
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Abstract
Measures to reduce the spread of COVID-19 have been associated with reduction in other respiratory infections. Results of a national Swedish cohort study of infant pertussis during April 2020-September 2021 were compared with those during January 2014-March 2020. The number of pertussis cases decreased significantly during the COVID-19 pandemic, from an average of 21 infant cases per quarter of a year before the pandemic to an average of 1 case per quarter during the pandemic. Swedish strategies to mitigate the spread of COVID-19 seem to have had an impact on pertussis incidence in infants.
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Affiliation(s)
| | - Emma Appelqvist
- Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, Solna, Sweden
| | | | | | - Lennart Jan Nilsson
- Allergy Center, Department of Biomedical and Clinical Sciences, Linkoping University, Linkoping, Sweden
| | - Sven-Arne Silfverdal
- Unit of Pediatrics, Department of Clinical Sciences/Paediatrics, Sven-Arne Silfverdal, Umeå University, Umeå, Sweden
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11
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Fritzell S, Källberg H, Busch H, Gustafsson P. Income-related inequalities in mental health in Sweden and the role of social determinants. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Mental health is an increasing concern in all European countries as the burden of mental disorders continue to grow and cause substantial suffering and costs to societies. Furthermore, research shows there are social inequalities in the distribution of mental illness. This study aims to increase knowledge on income-related inequalities in mental health in Sweden and the role of social determinants.
Methods
Drawing on a national survey (Health on Equal Terms) representative of the population aged 16-84, years 2010-2015 (n = 57107) we quantify the income-related inequality in mental health and estimate the contribution of social determinants of the inequality. Poor mental health is defined as a value of at least 3, based on the general health questionnaire (GHQ)-12. Income is measured as yearly disposable income. Income related inequalities in mental health are quantified by the concentration index and decomposed using the Wagstaff-type decomposition analysis.
Results
Preliminary results show that the income inequalities in mental health, as measured by the overall concentration index in mental health was - 0,16 (95% CI -0.17 to -0.15), indicating income inequalities to the disadvantage of those less affluent. The determinants that contributed most to the inequalities were employment, financial strain and experiencing harassment. Together they explained 43 % of the income inequalities in mental health. Generally, socio-economic factors had highest importance for the inequalities found, while demographic factors and psychosocial factors were of smaller importance.
Conclusions
The income related inequalities in mental health are substantial in Sweden. Recently, a national target of reducing the preventable inequalities in health within a generation was adopted. To improve surveillance of inequalities and inform policy we need to closely follow the development of inequalities in mental health and to disentangle the contribution of specific social determinants.
Key messages
Income-related inequalities in mental health in Sweden are considerable. Socio-economic factors had highest importance for the inequalities found, while demographic factors and psychosocial factors were of smaller importance.
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Affiliation(s)
- S Fritzell
- Public Health Agency of Sweden, Solna, Sweden
- Karolinska Institutet, Solna, Sweden
| | - H Källberg
- Public Health Agency of Sweden, Solna, Sweden
| | - H Busch
- Public Health Agency of Sweden, Solna, Sweden
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12
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Asker M, Holm LW, Källberg H, Waldén M, Skillgate E. Female adolescent elite handball players are more susceptible to shoulder problems than their male counterparts. Knee Surg Sports Traumatol Arthrosc 2018; 26:1892-1900. [PMID: 29427220 PMCID: PMC6061455 DOI: 10.1007/s00167-018-4857-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 02/02/2018] [Indexed: 10/31/2022]
Abstract
PURPOSE Shoulder problems are frequent among senior elite handball players. The objective of this study was to assess the prevalence of shoulder problems among adolescent elite handball players and to investigate potential differences in gender, school grade, playing position and playing level. METHODS During the 2014 and 2015 pre-season periods, 471 players (age 15-18 years, 54% female) completed a comprehensive baseline questionnaire regarding history of any shoulder pain and shoulder problems experienced during the past season. The players were monitored weekly for one competition season (September-April) regarding shoulder problems and the amount of match and training. Generalised linear models with a binomial link function were used to calculate a prevalence ratio (PR) with 95% confidence interval (CI) to compare the subgroups of players. RESULTS In total, 110 players (23%) reported having substantial shoulder problems (defined as moderate/severe reduction in training volume, or moderate/severe reduction in performance, or complete inability to participate) at some point during the follow-up season, of which almost half reported complete inability to participate. Of those players reporting substantial problems, 43% (95% CI 39-48) did so for at least 3 consecutive weeks during the season. The prevalence was significantly higher in female players (PR 1.46, 95% 1.04-2.06) and in backcourt players (PR 1.58, 95% CI 1.08-2.32), but no differences were found for school grade (PR 1.21 95% CI 0.88-1.67) or playing level (PR 1.09 95% CI 0.76-1.56). CONCLUSIONS The prevalence of substantial shoulder problems in adolescent elite handball players is high, especially among females, and this warrants further studies on risk factors for shoulder injury and the development of prevention strategies in handball players already before the age of 15. These findings also highlight the importance of introducing a clinical monitoring programme on a routine basis and improving the medical support, taking gender-related aspects into consideration, at handball-profiled secondary schools. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Martin Asker
- Musculoskeletal and Sports Injury Epidemiology Center, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. .,Naprapathögskolan-Scandinavian College of Naprapathic Manual Medicine, Stockholm, Sweden.
| | - Lena W. Holm
- 0000 0004 1937 0626grid.4714.6Musculoskeletal and Sports Injury Epidemiology Center, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Källberg
- 0000 0000 9580 3113grid.419734.cDepartment of Monitoring and Evaluation, Public Health Agency of Sweden, Solna, Sweden
| | - Markus Waldén
- 0000 0001 2162 9922grid.5640.7Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden ,Department of Orthopaedics, Hässleholm-Kristianstad-Ystad Hospitals, Hässleholm, Sweden
| | - Eva Skillgate
- 0000 0004 1937 0626grid.4714.6Musculoskeletal and Sports Injury Epidemiology Center, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden ,Naprapathögskolan-Scandinavian College of Naprapathic Manual Medicine, Stockholm, Sweden
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13
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Asker M, Waldén M, Källberg H, Holm LW, Skillgate E. A prospective cohort study identifying risk factors for shoulder injuries in adolescent elite handball players: the Karolinska Handball Study (KHAST) study protocol. BMC Musculoskelet Disord 2017; 18:485. [PMID: 29166930 PMCID: PMC5700469 DOI: 10.1186/s12891-017-1852-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 11/15/2017] [Indexed: 11/25/2022] Open
Abstract
Background Handball is a physical contact sport that includes frequent overhead throwing, and this combination leads to a high rate of shoulder injuries. Several factors have been associated with shoulder injuries in overhead athletes, but strong scientific evidence is lacking for most suggested risk factors. We therefore designed the Karolinska Handball Study (KHAST) with the aim to identify risk factors for shoulder injuries in adolescent male and female elite handball players studying at handball-profiled secondary schools in Sweden. Secondary objectives are to investigate whether shoulder function changes during the competition season and whether the physical profile of the players changes during their time in secondary school. Methods Players aged 15 to 19 years were included during the pre-season period of the 2014–2015 and the 2015–2016 seasons. At inclusion, players signed informed consent and filled in a questionnaire regarding playing position, playing level, previous handball experience, history of shoulder problems and athletic identity. Players also completed a detailed test battery at baseline evaluating the shoulder, neck and trunk. Players were then prospectively monitored weekly during the 2014–2015 and/or 2015–2016 competitive seasons regarding injuries and training/match workload. Results from the annual routine physical tests in the secondary school curriculum including bench press, deep squat, hand grip strength, clean lifts, squat jumps, counter movement jumps, <30 m sprints, chins, dips and Cooper’s test will be collected until the end of the competitive season 2017–2018. The primary outcome is the incidence of shoulder injuries and shoulder problems. The secondary outcome is the prevalence of shoulder injuries and shoulder problems. Discussion Shoulder problems are frequent among handball players and a reduction of these injuries is therefore warranted. However, in order to introduce appropriate preventive measures, a detailed understanding of the underlying risk factors is needed. Our study has a high potential to identify important risk factors for shoulder injuries in adolescent elite handball players owing to a large study sample, a high response rate, data collection during consecutive seasons, and recording of potential confounding factors. Electronic supplementary material The online version of this article (10.1186/s12891-017-1852-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Martin Asker
- Musculoskeletal & Sports Injury Epidemiology Center, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. .,Naprapathögskolan - Scandinavian College of Naprapathic Manual Medicine, Stockholm, Sweden.
| | - Markus Waldén
- Department of Medical and Health Sciences, Division of Community Medicine, Linköping University, Linköping, Sweden.,Department of Orthopaedics, Hässleholm-Kristianstad-Ystad Hospitals, Hässleholm, Sweden
| | - Henrik Källberg
- Musculoskeletal & Sports Injury Epidemiology Center, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Monitoring and Evaluation, Public Health Agency of Sweden, Solna, Sweden
| | - Lena W Holm
- Musculoskeletal & Sports Injury Epidemiology Center, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, M5T 3M6, Canada
| | - Eva Skillgate
- Musculoskeletal & Sports Injury Epidemiology Center, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Naprapathögskolan - Scandinavian College of Naprapathic Manual Medicine, Stockholm, Sweden
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14
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Westerlind H, Mellander MR, Bresso F, Munch A, Bonfiglio F, Assadi G, Rafter J, Hübenthal M, Lieb W, Källberg H, Brynedal B, Padyukov L, Halfvarson J, Törkvist L, Bjork J, Andreasson A, Agreus L, Almer S, Miehlke S, Madisch A, Ohlsson B, Löfberg R, Hultcrantz R, Franke A, D'Amato M. Dense genotyping of immune-related loci identifies HLA variants associated with increased risk of collagenous colitis. Gut 2017; 66:421-428. [PMID: 26525574 DOI: 10.1136/gutjnl-2015-309934] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 10/11/2015] [Accepted: 10/12/2015] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Collagenous colitis (CC) is a major cause of chronic non-bloody diarrhoea, particularly in the elderly female population. The aetiology of CC is unknown, and still poor is the understanding of its pathogenesis. This possibly involves dysregulated inflammation and immune-mediated reactions in genetically predisposed individuals, but the contribution of genetic factors to CC is underinvestigated. We systematically tested immune-related genes known to impact the risk of several autoimmune diseases for their potential CC-predisposing role. DESIGN Three independent cohorts of histologically confirmed CC cases (N=314) and controls (N=4299) from Sweden and Germany were included in a 2-step association analysis. Immunochip and targeted single nucleotide polymorphism (SNP) genotype data were produced, respectively, for discovery and replication purposes. Classical human leucocyte antigen (HLA) variants at 2-digit and 4-digit resolution were obtained via imputation from single marker genotypes. SNPs and HLA variants passing quality control filters were tested for association with CC with logistic regression adjusting for age, sex and country of origin. RESULTS Forty-two markers gave rise to genome-wide significant association signals, all contained within the HLA region on chromosome 6 (best p=4.2×10-10 for SNP rs4143332). Among the HLA variants, most pronounced risk effects were observed for 8.1 haplotype alleles including DQ2.5, which was targeted and confirmed in the replication data set (p=2.3×10-11; OR=2.06; 95% CI (1.67 to 2.55) in the combined analysis). CONCLUSIONS HLA genotype associates with CC, thus implicating HLA-related immune mechanisms in its pathogenesis.
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Affiliation(s)
- Helga Westerlind
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | - Marie-Rose Mellander
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Gastrocentrum, Karolinska University Hospital, Stockholm, Sweden
| | - Francesca Bresso
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Gastrocentrum, Karolinska University Hospital, Stockholm, Sweden
| | - Andreas Munch
- Department of Clinical and Experimental Medicine, Faculty of Health Science, Linköpings University, Linköping, Sweden
| | - Ferdinando Bonfiglio
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | - Ghazaleh Assadi
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | - Joseph Rafter
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | - Matthias Hübenthal
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Wolfgang Lieb
- Institute of Epidemiology and Biobank POPGEN, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Henrik Källberg
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Boel Brynedal
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Leonid Padyukov
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Halfvarson
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Leif Törkvist
- Gastrocentrum, Karolinska University Hospital, Stockholm, Sweden
| | - Jan Bjork
- Gastrocentrum, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Andreasson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Lars Agreus
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Sven Almer
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Gastrocentrum, Karolinska University Hospital, Stockholm, Sweden
| | - Stephan Miehlke
- Center for Digestive Diseases, Internal Medicine Center Eppendorf, Hamburg, Germany
| | - Ahmed Madisch
- Clinic for Gastroenterology, Endoscopy and Interventional Diabetology, Siloah Hospital, Hannover, Germany
| | - Bodil Ohlsson
- Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Robert Löfberg
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Sophiahemmet Hospital, Stockholm, Sweden
| | - Rolf Hultcrantz
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Andre Franke
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Mauro D'Amato
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
- BioCruces Health Research Institute and IKERBASQUE, Basque Foundation for Science, Bilbao, Spain
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15
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Asker M, Holm LW, Källberg H, Waldén M, Skillgate E. HIGH PREVALENCE OF SUBSTANTIAL SHOULDER PROBLEMS AMONG ELITE ADOLESCENT HANDBALL PLAYERS: THE KAROLINSKA HANDBALL STUDY. Br J Sports Med 2017. [DOI: 10.1136/bjsports-2016-097372.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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16
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Pikwer M, Orellana C, Källberg H, Pikwer A, Turesson C, Klareskog L, Alfredsson L, Saevarsdottir S, Bengtsson C. Parity influences the severity of ACPA-negative early rheumatoid arthritis: a cohort study based on the Swedish EIRA material. Arthritis Res Ther 2015; 17:358. [PMID: 26653988 PMCID: PMC4704530 DOI: 10.1186/s13075-015-0869-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 11/20/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In women with rheumatoid arthritis (RA) it has been observed that during pregnancy a majority of patients experience amelioration, but after delivery a relapse of the disease is common. However, there are few studies, with diverging results, addressing the effect of parity on the severity of RA over time. Our aim was to explore the impact of parity, with stratification for anti-citrullinated protein antibody (ACPA) status as well as for onset during reproductive age or not. METHODS Female RA cases aged 18-70 years were recruited for the Epidemiological Investigation of Rheumatoid Arthritis (EIRA). Information on disease severity (the health assessment questionnaire (HAQ) and the disease activity score 28 (DAS28)) was retrieved from the Swedish Rheumatology Quality Register at inclusion and 3, 6, 12 and 24 months after diagnosis. Mixed models were used to compare mean DAS28 and HAQ scores over time in parous and nulliparous women. Mean differences at individual follow-up visits were compared using analysis of covariance. The odds of having DAS28 or HAQ above the median in parous verus nulliparous women were estimated in logistic regression models. RESULTS A total of 1237 female cases (mean age 51 years, 65 % ACPA-positive) were included. ACPA-negative parous women, aged 18-44 years, had on average 1.17 units higher DAS28 (p < 0.001) and 0.43 units higher HAQ score (p < 0.001) compared to nulliparous women during the follow-up time, adjusted for age. In this subgroup, the average DAS28 and HAQ scores were significantly higher in parous women at all follow-up time points. Younger parous ACPA-negative women were significantly more likely to have DAS28 and HAQ values above the median compared to nulliparous women at all follow-up visits. No association between parity and severity of ACPA-positive disease was observed. CONCLUSIONS Parity was a predictor of a more severe RA among ACPA-negative younger women, which might indicate that immunomodulatory changes during and after pregnancy affect RA severity, in particular for the ACPA-negative RA phenotype.
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Affiliation(s)
- Mitra Pikwer
- Rheumatology Unit, Mälarsjukhuset Hospital, Eskilstuna, Sweden. .,Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. .,Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden. .,Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden.
| | - Cecilia Orellana
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Henrik Källberg
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Andreas Pikwer
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden.
| | - Carl Turesson
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden.
| | - Lars Klareskog
- Rheumatology Unit, Department of Medicine, Karolinska Institutet and Karolinska University Hospital Solna, Stockholm, Sweden.
| | - Lars Alfredsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. .,Centre of Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden.
| | - Saedis Saevarsdottir
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. .,Rheumatology Unit, Department of Medicine, Karolinska Institutet and Karolinska University Hospital Solna, Stockholm, Sweden.
| | - Camilla Bengtsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
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17
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Jiang X, Källberg H, Chen Z, Ärlestig L, Rantapää-Dahlqvist S, Davila S, Klareskog L, Padyukov L, Alfredsson L. An Immunochip-based interaction study of contrasting interaction effects with smoking in ACPA-positive versus ACPA-negative rheumatoid arthritis. Rheumatology (Oxford) 2015; 55:149-55. [PMID: 26272072 DOI: 10.1093/rheumatology/kev285] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To investigate the gene-environment interaction between smoking and single nucleotide polymorphisms (SNPs), using Immunochip material, on the risk of developing either of two serologically defined subsets of RA. METHODS Interaction between smoking and 133,648 genetic markers from the Immunochip was examined for two RA subsets, defined by the presence or absence of ACPA. A total of 1590 ACPA-positive and 891 ACPA-negative cases were compared with 1856 controls in the Swedish Epidemiological Investigation of RA (EIRA) case-control study. Logistic regression models were used to determine the presence of interaction. The proportion attributable to interaction was calculated for each smoking-SNP pair. Replication was carried out in an independent dataset from northern Sweden. To further validate and extend the results, interaction analysis was also performed using genome-wide association studies data on EIRA individuals. RESULTS In ACPA-positive RA, 102 SNPs interacted significantly with smoking, after Bonferroni correction. All 102 SNPs were located in the HLA region, mainly within the HLA class II region, 51 of which were replicated. No additional loci outside chromosome 6 were identified in the genome-wide association studies validation. After adjusting for HLA-DRB1 shared epitope, 15 smoking-SNP pairs remained significant for ACPA-positive RA, with 8 of these replicated (loci: BTNL2, HLA-DRA, HLA-DRB5, HLA-DQA1, HLA-DOB and TAP2). For ACPA-negative RA, no smoking-SNP pairs passed the threshold for significance. CONCLUSION Our study presents extended gene variation patterns involved in gene-smoking interaction in ACPA-positive, but not ACPA-negative, RA. Notably, variants in HLA-DRB1 and those in additional genes within the MHC class II region, but not in any other gene regions, showed interaction with smoking.
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Affiliation(s)
- Xia Jiang
- The Institute of Environmental Medicine, Karolinska Institute, Stockholm,
| | - Henrik Källberg
- The Institute of Environmental Medicine, Karolinska Institute, Stockholm
| | - Zuomei Chen
- The Institute of Environmental Medicine, Karolinska Institute, Stockholm
| | - Lisbeth Ärlestig
- Department of Public Health and Clinical Medicine, Rheumatology, Umeå University, Umeå, Sweden
| | | | - Sonia Davila
- Human Genetics, Genome Institute of Singapore, Singapore
| | - Lars Klareskog
- Rheumatology Unit, Department of Medicine, Karolinska Institute and
| | - Leonid Padyukov
- Rheumatology Unit, Department of Medicine, Karolinska Institute and
| | - Lars Alfredsson
- The Institute of Environmental Medicine, Karolinska Institute, Stockholm, Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
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18
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Moreno Velásquez I, Golabkesh Z, Källberg H, Leander K, de Faire U, Gigante B. Circulating levels of interleukin 6 soluble receptor and its natural antagonist, sgp130, and the risk of myocardial infarction. Atherosclerosis 2015; 240:477-81. [PMID: 25910182 DOI: 10.1016/j.atherosclerosis.2015.04.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 04/11/2015] [Accepted: 04/13/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To investigate the association between circulating levels of the soluble interleukin 6 receptor (sIL6R) and the soluble gp130 (sgp130) with myocardial infarction (MI) and to explore the potential interaction between sIL6R and sgp130 in this association. METHODS Study population is the Stockholm Heart Epidemiology Program (SHEEP), a population-based case-control study. SIL6R (ng/mL) and sgp130 (ng/mL) levels were measured in serum samples from 682 and 664 MI cases and 1103 and 1062 controls, respectively. Odds ratios (with 95% CIs) for MI were calculated using unconditional logistic regression. We adjusted for age, sex, hospital catchment area (crude) and for hypertension, diabetes, hypercholesterolemia, body mass index and smoking (adjusted model). Synergy index (S) and attributable proportion (AP) were estimated as measures of biological interaction. RESULTS Elevated concentrations of sIL6R (>75th percentile value) were associated with an increased occurrence of MI (compared to ≤75th percentile), with an adjusted OR of 1.4 (95% CI, 1.1-1.8). Very high (>90th percentile value) levels of sgp130 were associated with a reduced occurrence of MI [OR 0.7 (95% CI, 0.5-0.9)] (adjusted). There was an indication of a possible interaction between high sIL6R and low sgp130 (adjusted S score 1.7, 95% CI = 0.5-6.1; AP 0.19, 95% CI = -0.2-0.5), suggesting that low sgp130 levels may synergize with high sIL6R levels to increase risk of MI. CONCLUSIONS sIL6R and sgp130 had opposing associations with MI. Indeed, circulating sgp130 levels may modify the association of elevated sIL6R levels with MI.
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Affiliation(s)
- Ilais Moreno Velásquez
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Sweden
| | - Zahra Golabkesh
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Sweden
| | - Henrik Källberg
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Sweden
| | - Karin Leander
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Sweden
| | - Ulf de Faire
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Sweden; Dept of Cardiology, Karolinska University Hospital, Sweden
| | - Bruna Gigante
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Sweden; Division of Cardiovascular Medicine, Dept of Clinical Sciences, Danderyd University Hospital Stockholm, Sweden.
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19
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Jiang X, Frisell T, Askling J, Karlson EW, Klareskog L, Alfredsson L, Källberg H. To What Extent Is the Familial Risk of Rheumatoid Arthritis Explained by Established Rheumatoid Arthritis Risk Factors? Arthritis Rheumatol 2015; 67:352-62. [DOI: 10.1002/art.38927] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 10/21/2014] [Indexed: 01/03/2023]
Affiliation(s)
- Xia Jiang
- Karolinska InstitutetStockholmSweden
| | | | - Johan Askling
- Karolinska Institutet and Karolinska University Hospital SolnaStockholmSweden
| | | | | | - Lars Alfredsson
- Karolinska Institutet and Centre for Occupational and Environmental Medicine, Stockholm County CouncilStockholmSweden
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20
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Sandberg MEC, Bengtsson C, Källberg H, Wesley A, Klareskog L, Alfredsson L, Saevarsdottir S. Response to: 'Obesity and comorbidity are independently associated with a failure to achieve remission in patients with established rheumatoid arthritis' by Ellerby et al. Ann Rheum Dis 2014; 73:e79. [PMID: 25261581 DOI: 10.1136/annrheumdis-2014-206369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Maria E C Sandberg
- Department of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Camilla Bengtsson
- Department of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Källberg
- Department of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Annmarie Wesley
- Department of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lars Klareskog
- Department of Rheumatology, Karolinska Institutet, Stockholm, Sweden
| | - Lars Alfredsson
- Department of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Saedis Saevarsdottir
- Department of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden Department of Rheumatology, Karolinska Institutet, Stockholm, Sweden
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Abstract
A common goal of epidemiologic research is to study how two exposures interact in causing a binary outcome. Sufficient-cause interaction is a special type of mechanistic interaction, which requires that two events (e.g. specific exposure levels from two risk factors) are necessary in order for the outcome to occur. Recently, tests have been derived to establish the presence of sufficient-cause interactions, for categorical exposures with at most three levels. In this paper we derive prevalence bounds, i.e. lower and upper bounds on the prevalence of subjects for which sufficient-cause interaction is present. The derived bounds hold for categorical exposures with arbitrary many levels. We apply the bounds to data from a study of gene-gene interaction in the development of Rheumatoid Arthritis. We provide an R-program to estimate the bounds from real data .
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Affiliation(s)
- Arvid Sjölander
- Department of Medical Epidemiology, Karolinska Institute, Stockholm, Sweden,
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22
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Lekman M, Hössjer O, Andrews P, Källberg H, Uvehag D, Charney D, Manji H, Rush JA, McMahon FJ, Moore JH, Kockum I. The genetic interacting landscape of 63 candidate genes in Major Depressive Disorder: an explorative study. BioData Min 2014; 7:19. [PMID: 25279001 PMCID: PMC4181757 DOI: 10.1186/1756-0381-7-19] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 07/28/2014] [Indexed: 12/17/2022] Open
Abstract
Background Genetic contributions to major depressive disorder (MDD) are thought to result from multiple genes interacting with each other. Different procedures have been proposed to detect such interactions. Which approach is best for explaining the risk of developing disease is unclear. This study sought to elucidate the genetic interaction landscape in candidate genes for MDD by conducting a SNP-SNP interaction analysis using an exhaustive search through 3,704 SNP-markers in 1,732 cases and 1,783 controls provided from the GAIN MDD study. We used three different methods to detect interactions, two logistic regressions models (multiplicative and additive) and one data mining and machine learning (MDR) approach. Results Although none of the interaction survived correction for multiple comparisons, the results provide important information for future genetic interaction studies in complex disorders. Among the 0.5% most significant observations, none had been reported previously for risk to MDD. Within this group of interactions, less than 0.03% would have been detectable based on main effect approach or an a priori algorithm. We evaluated correlations among the three different models and conclude that all three algorithms detected the same interactions to a low degree. Although the top interactions had a surprisingly large effect size for MDD (e.g. additive dominant model Puncorrected = 9.10E-9 with attributable proportion (AP) value = 0.58 and multiplicative recessive model with Puncorrected = 6.95E-5 with odds ratio (OR estimated from β3) value = 4.99) the area under the curve (AUC) estimates were low (< 0.54). Moreover, the population attributable fraction (PAF) estimates were also low (< 0.15). Conclusions We conclude that the top interactions on their own did not explain much of the genetic variance of MDD. The different statistical interaction methods we used in the present study did not identify the same pairs of interacting markers. Genetic interaction studies may uncover previously unsuspected effects that could provide novel insights into MDD risk, but much larger sample sizes are needed before this strategy can be powerfully applied.
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Affiliation(s)
- Magnus Lekman
- Department of Clinical Neuroscience, Neuroimmunology Unit, Karolinska Institutet, Stockholm, Sweden
| | - Ola Hössjer
- Department of Mathematics, Stockholm University, Stockholm, Sweden
| | - Peter Andrews
- Institute of Quantitative Biomedical Science, Department of Genetics and Community and Family Medicine, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Henrik Källberg
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Daniel Uvehag
- Department of Clinical Neuroscience, Neuroimmunology Unit, Karolinska Institutet, Stockholm, Sweden
| | - Dennis Charney
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
| | - Husseini Manji
- Laboratory of Molecular Pathophysiology, NIMH, NIH, Department of Health & Human Services (DHHS), Bethesda, USA
| | - John A Rush
- Academic Medical Research Institute, Duke-National University of Singapore, Singapore, Singapore
| | - Francis J McMahon
- Genetic Basis of Mood & Anxiety Disorders Section, Human Genetic Branch, NIMH, NIH, Department of Health & Human Services (DHHS), Bethesda, USA
| | - Jason H Moore
- Institute of Quantitative Biomedical Science, Department of Genetics and Community and Family Medicine, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Ingrid Kockum
- Department of Clinical Neuroscience, Neuroimmunology Unit, Karolinska Institutet, Stockholm, Sweden
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Coenen M, Umićević Mirkov M, Krintel S, Johansen J, Miceli-Richard C, Källberg H, Padyukov L, Scheffer H, Kievit W, van de Laar M, van Riel P, Mariette X, Saevarsdottir S, Hetland M, Vermeulen S, Albers C. THU0478 Genome-Wide Association Analysis of Pain Reduction in Rheumatoid Arthritis Patients Treated with TNF Inhibitors. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Jiang X, Frisell T, Askling J, Klareskog L, Alfredsson L, Källberg H. FRI0368 To Which Extent May the Familial Risk of Rheumatoid Arthritis BE Explained by Established Risk Factors? Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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25
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Sandberg MEC, Bengtsson C, Källberg H, Wesley A, Klareskog L, Alfredsson L, Saevarsdottir S. Overweight decreases the chance of achieving good response and low disease activity in early rheumatoid arthritis. Ann Rheum Dis 2014; 73:2029-33. [DOI: 10.1136/annrheumdis-2013-205094] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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26
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Jiang X, Trouw LA, van Wesemael TJ, Shi J, Bengtsson C, Källberg H, Malmström V, Israelsson L, Hreggvidsdottir H, Verduijn W, Klareskog L, Alfredsson L, Huizinga TWJ, Toes REM, Lundberg K, van der Woude D. Anti-CarP antibodies in two large cohorts of patients with rheumatoid arthritis and their relationship to genetic risk factors, cigarette smoking and other autoantibodies. Ann Rheum Dis 2014; 73:1761-8. [DOI: 10.1136/annrheumdis-2013-205109] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Gustafsson JT, Gunnarsson I, Källberg H, Pettersson S, Zickert A, Vikerfors A, Möller S, Rönnelid J, Elvin K, Svenungsson E. Cigarette smoking, antiphospholipid antibodies and vascular events in Systemic Lupus Erythematosus. Ann Rheum Dis 2014; 74:1537-43. [PMID: 24692586 DOI: 10.1136/annrheumdis-2013-205159] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 03/16/2014] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Smoking can induce autoantibodies in persons who are genetically predisposed to rheumatoid arthritis. We investigated the association between smoking and antiphospholipid antibodies (aPL) in systemic lupus erythematosus (SLE), a question not previously addressed. Further, we explored the relationship between smoking, aPL and vascular events (arterial and venous, VE). METHODS In this cross-sectional study, clinical evaluation and questionnaire data were collected from 367 prevalent SLE patients. At the same time, we measured aPL (anticardiolipin (aCL), anti-β2 glycoprotein-1 (aβ2GP1) antibodies IgG/IgM/IgA, and lupus anticoagulant (LA)), and a large set of other SLE-associated autoantibodies for comparison. Association analyses using logistic regression models with smoking, (ever, former and current with never as reference) and antibody status as outcome variable were performed. As a secondary outcome, we investigated the associations between aPL, smoking and VE. RESULTS In multivariable-adjusted models ever, and in particular former, cigarette smoking was associated with the most pathogenic aPL; LA, aCL IgG and aβ2GP1 IgG. Other SLE-associated autoantibodies were not associated with smoking. The combination of smoking and aPL was strongly associated with VE. We noted a positive interaction between smoking-LA and smoking-'triple aPL' positivity for previous VE. CONCLUSIONS We investigated a large set of commonly occurring autoantibodies in SLE, but only aPL were positively associated with a history of smoking. This association was especially apparent in former smokers. Among ever regular smokers who were aPL positive, we observed a strikingly high frequency of former VE. The underlying mechanisms and temporality between smoking, aPL and VE need further investigations.
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Affiliation(s)
- Johanna T Gustafsson
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Iva Gunnarsson
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Källberg
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Susanne Pettersson
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Agneta Zickert
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Anna Vikerfors
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Sonia Möller
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Johan Rönnelid
- Department of Immunology, Genetics and Pathology, Rudbeck Laboratory C5, Uppsala University, Uppsala, Sweden
| | - Kerstin Elvin
- Unit of Clinical Immunology, Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Elisabet Svenungsson
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm, Sweden
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Sjölander A, Lee W, Källberg H, Pawitan Y. Bounds on causal interactions for binary outcomes. Biometrics 2014; 70:500-5. [PMID: 24621448 DOI: 10.1111/biom.12166] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Revised: 10/01/2013] [Accepted: 02/01/2014] [Indexed: 01/14/2023]
Abstract
A common goal of epidemiologic research is to study how two exposures interact in causing a binary outcome. Causal interaction is defined as the presence of subjects for which the causal effect of one exposure depends on the level of the other exposure. For binary exposures, it has previously been shown that the presence of causal interaction is testable through additive statistical interaction. However, it has also been shown that the magnitude of causal interaction, defined as the proportion of subjects for which there is causal interaction, is generally not identifiable. In this article, we derive bounds on causal interactions, which are applicable to binary outcomes and categorical exposures with arbitrarily many levels. These bounds can be used to assess the magnitude of causal interaction, and serve as an important complement to the statistical test that is frequently employed. The bounds are derived both without and with an assumption about monotone exposure effects. We present an application of the bounds to a study of gene-gene interaction in rheumatoid arthritis.
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Affiliation(s)
- A Sjölander
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - W Lee
- Department of Statistics, Inha University, Incheon, Korea
| | - H Källberg
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Y Pawitan
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Jiang X, Trouw LA, van Wesemael TJ, Shi J, Källberg H, Malmström V, Israelsson L, Hreggvidsdottir H, Verduijn W, Klareskog L, Alfredsson L, Huizinga TWJ, Toes REM, Lundberg K, van der Woude D. A1.28 Anti-carp antibodies in two large cohorts of patients with rheumatoid arthritis and their relationship to genetic risk factors and smoking. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2013-205124.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Frisell T, Holmqvist M, Källberg H, Klareskog L, Alfredsson L, Askling J. Familial risks and heritability of rheumatoid arthritis: role of rheumatoid factor/anti-citrullinated protein antibody status, number and type of affected relatives, sex, and age. ACTA ACUST UNITED AC 2014; 65:2773-82. [PMID: 23897126 DOI: 10.1002/art.38097] [Citation(s) in RCA: 126] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 07/16/2013] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To estimate familial aggregation of rheumatoid arthritis (RA) in 3 large population-representative samples and to test if familial aggregation is affected by rheumatoid factor (RF)/anti-citrullinated protein antibody (ACPA) status, type of relative, sex, and age at onset of RA. METHODS A register-based nested case-control study was performed in the Swedish total population. Data on patients with RA were ascertained through the nationwide Swedish Patient Register (n = 88,639), the clinical Swedish Rheumatology Quality Register (n = 11,519), and the Epidemiological Investigation of Rheumatoid Arthritis case-control study (n = 2,871). Data on first- and second-degree relatives were obtained through the Swedish Multigeneration Register. Familial risks were calculated using conditional logistic regression. RESULTS Consistent across data sources, the familial odds ratio for RA was ∼3 in first-degree relatives of RA patients and 2 in second-degree relatives. Familial risks were similar among siblings, parents, and offspring. Familial aggregation was not modified by sex, but was higher in RA patients with early-onset disease and in RF/ACPA-positive RA patients. The observed familial risks were consistent with a heritability of ∼50% for ACPA-positive RA and ∼20% for ACPA-negative RA. CONCLUSION The pattern of risks suggests that familial factors influence RA in men and women equally and that these factors are of less importance for late-onset RA. Familial factors are more important for seropositive RA, but there is significant familial overlap between seropositive RA and seronegative RA. Even if the familial risk is assumed to be completely due to genetics, the observed risks suggest that heritability of RA is lower than previously reported, in particular for ACPA-negative RA.
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31
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Maehlen MT, Olsen IC, Andreassen BK, Viken MK, Jiang X, Alfredsson L, Källberg H, Brynedal B, Kurreeman F, Daha N, Toes R, Zhernakova A, Gutierrez-Achury J, de Bakker PIW, Martin J, Teruel M, Gonzalez-Gay MA, Rodríguez-Rodríguez L, Balsa A, Uhlig T, Kvien TK, Lie BA. Genetic risk scores and number of autoantibodies in patients with rheumatoid arthritis. Ann Rheum Dis 2013; 74:762-8. [PMID: 24336335 DOI: 10.1136/annrheumdis-2013-204173] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Certain HLA-DRB1 alleles and single-nucleotide polymorphisms (SNPs) are associated with rheumatoid arthritis (RA). Our objective was to examine the combined effect of these associated variants, calculated as a cumulative genetic risk score (GRS) on RA predisposition, as well as the number of autoantibodies (none, one or two present). METHOD We calculated four GRSs in 4956 patients and 4983 controls from four European countries. All four scores contained data on 22 non-HLA-risk SNPs, and three scores also contained HLA-DRB1 genotypes but had different HLA typing resolution. Most patients had data on both rheumatoid factor (RF) and anti-citrullinated proteins antibodies (ACPA). The GRSs were standardised (std.GRS) to account for population heterogeneity. Discrimination between patients and controls was examined by receiveroperating characteristics curves, and the four std.GRSs were compared across subgroups according to autoantibody status. RESULTS The std.GRS improved its discriminatory ability between patients and controls when HLA-DRB1 data of higher resolution were added to the combined score. Patients had higher mean std.GRS than controls (p=7.9×10(-156)), and this score was significantly higher in patients with autoantibodies (shown for both RF and ACPA). Mean std.GRS was also higher in those with two versus one autoantibody (p=3.7×10(-23)) but was similar in patients without autoantibodies and controls (p=0.12). CONCLUSIONS The GRS was associated with the number of autoantibodies and to both RF and ACPA positivity. ACPA play a more important role than RF with regards to the genetic risk profile, but stratification of patients according to both RF and ACPA may optimise future genetic studies.
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Affiliation(s)
- Marthe T Maehlen
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway Department of Medical Genetics, University of Oslo and Oslo University Hospital, Ullevål, Oslo, Norway
| | - Inge C Olsen
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Bettina K Andreassen
- Department of EpiGen, Institute of Clinical Medicine, University of Oslo, Oslo, Norway Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Marte K Viken
- Department of Medical Genetics, University of Oslo and Oslo University Hospital, Ullevål, Oslo, Norway
| | - Xia Jiang
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Lars Alfredsson
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Henrik Källberg
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Boel Brynedal
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Fina Kurreeman
- Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Nina Daha
- Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Rene Toes
- Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Alexandra Zhernakova
- Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands Department of Genetics, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
| | - Javier Gutierrez-Achury
- Department of Genetics, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
| | - Paul I W de Bakker
- Departments of Medical Genetics and of Epidemiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Javier Martin
- Instituto de Parasitologia y Biomedicina Lopez-Neyra, CSIC, Granada, Spain
| | - María Teruel
- Instituto de Parasitologia y Biomedicina Lopez-Neyra, CSIC, Granada, Spain
| | | | | | | | - Till Uhlig
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Benedicte A Lie
- Department of Medical Genetics, University of Oslo and Oslo University Hospital, Ullevål, Oslo, Norway
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Hart JE, Källberg H, Laden F, Costenbader KH, Yanosky JD, Klareskog L, Alfredsson L, Karlson EW. Ambient air pollution exposures and risk of rheumatoid arthritis. Arthritis Care Res (Hoboken) 2013; 65:1190-6. [PMID: 23401426 DOI: 10.1002/acr.21975] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 01/29/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Environmental factors may play a role in the development of rheumatoid arthritis (RA). We previously observed increased RA risk among women living closer to major roads (a source of air pollution). Herein, we examined whether long-term exposures to specific air pollutants were associated with RA risk among women in the Nurses' Health Study (NHS). METHODS The NHS is a large US cohort of female nurses followed up prospectively every 2 years since 1976. We studied 111,425 NHS participants with information on air pollution exposures as well as data concerning other lifestyle and behavioral exposures and disease outcomes. Outdoor levels of different size fractions of particulate matter (PM10 and PM2.5 ) and gaseous pollutants (SO2 and NO2 ) were predicted for all available residential addresses using monitoring data from the US Environmental Protection Agency. We examined the association of time-varying exposures 6 and 10 years before each questionnaire cycle and cumulative average exposure with the risk of RA, seronegative (rheumatoid factor and anti-citrullinated peptide antibody negative) RA, and seropositive RA. RESULTS Over the 3,019,424 person-years of followup, 858 incident RA cases were validated by medical record review by 2 board-certified rheumatologists. Overall, we found no evidence of increased risk of RA, seronegative RA, or seropositive RA with exposure to the different pollutants and little evidence of effect modification by socioeconomic status or smoking status, geographic region, or calendar period. CONCLUSION In this group of socioeconomically advantaged middle-aged and elderly women, adult exposures to air pollution were not associated with an increased RA risk.
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Affiliation(s)
- Jaime E Hart
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Orellana C, Wedrén S, Källberg H, Holmqvist M, Karlson EW, Alfredsson L, Bengtsson C. Parity and the risk of developing rheumatoid arthritis: results from the Swedish Epidemiological Investigation of Rheumatoid Arthritis study. Ann Rheum Dis 2013; 73:752-5. [PMID: 23887288 DOI: 10.1136/annrheumdis-2013-203567] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To study the impact of parity history on the risk of antibodies to citrullinated peptide antigens (ACPA) positive and ACPA-negative rheumatoid arthritis (RA), in different age-groups. METHOD Data from a population-based case-control study of female incident RA cases were analysed (2035 cases and 2911 controls, aged 18-70 years ). Parity history was assessed through a questionnaire. Parous women were compared with nulliparous, by calculating odds ratios (ORs) with 95% confidence interval (CI). RESULTS Parity was associated with an increased risk of ACPA-negative RA in women aged 18-44 years (OR=2.1, 95% CI 1.4 to 3.2), but not in those aged 45-70 years (OR=0.9, 95% CI 0.7 to 1.3). Among young women, an increased risk of ACPA-negative RA was found in those who gave birth during the year of symptom onset (OR=2.6, 95% CI 1.4 to 4.8) and who were at a young age at first birth (<23) (OR=2.5, 95% CI 1.5 to 4.1). Parity and the postpartum period were not associated with ACPA-positive RA, but older age at first birth was weakly associated with a decreased risk. CONCLUSIONS The increased risk of ACPA-negative RA in parous women of reproductive age seemed to be associated with an increased postpartum risk and with young age at first birth. Further research is needed to explore the biological mechanisms behind our findings.
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Affiliation(s)
- Cecilia Orellana
- Institute of Environmental Medicine, Karolinska Institutet, , Stockholm, Sweden
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Skog A, Eliasson H, Tingström J, Källberg H, Salomonsson S, Sonesson SE, Wahren-Herlenius M. Long-term growth of children with autoantibody-mediated congenital heart block. Acta Paediatr 2013; 102:718-26. [PMID: 23551183 DOI: 10.1111/apa.12248] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 03/07/2013] [Accepted: 03/21/2013] [Indexed: 11/28/2022]
Abstract
AIM To analyse growth of children with and without congenital heart block (CHB) born to anti-Ro/SSA positive mothers from birth to 18 years of age, using a population-based cohort of Swedish CHB patients. METHODS Medical records for siblings with (n = 72) and without (n = 60) CHB born 1973-2009 to anti-Ro/SSA positive mothers were retrieved from child healthcare centres and school health services and used to extract data on growth from birth to 18 years. RESULTS Compared with reference standards, children with CHB were retarded in weight by 0.75-1.0 SD from birth to 2-3 years of age. Thereafter, the CHB children started to catch up, reaching the reference standards at 9-11 years of age. Pacemaker treatment was not correlated with the catch-up in growth. Individuals with CHB were retarded in both weight and height from birth to 9-11 years of age when compared to siblings without CHB, who did not demonstrate restriction in these measurements. CONCLUSION Presence of CHB is a more important predictor of growth restriction than maternal rheumatic disease and foetal anti-Ro/SSA exposure. The restriction persists for several years after birth, despite pacemaker treatment, which highlights the importance of follow-up of children with CHB regarding nutrition and growth.
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Affiliation(s)
- Amanda Skog
- Rheumatology Unit; Department of Medicine; Karolinska Institutet; Stockholm; Sweden
| | - Håkan Eliasson
- Pediatric Cardiology Unit; Department of Women's and Children's health; Karolinska Institutet; Stockholm; Sweden
| | - Joanna Tingström
- Rheumatology Unit; Department of Medicine; Karolinska Institutet; Stockholm; Sweden
| | - Henrik Källberg
- Unit of Cardiovascular Epidemiology, Department of Environmental Medicine; Karolinska Institutet; Stockholm; Sweden
| | - Stina Salomonsson
- Rheumatology Unit; Department of Medicine; Karolinska Institutet; Stockholm; Sweden
| | - Sven-Erik Sonesson
- Pediatric Cardiology Unit; Department of Women's and Children's health; Karolinska Institutet; Stockholm; Sweden
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Frisell T, Holmqvist M, Källberg H, Klareskog L, Alfredsson L, Padyukov L, Askling J. THU0105 Familial Risks of RA in Relation to Type of Affected Relatives, Age, Sex, and RF/ACPA. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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36
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Jiang X, Källberg H, Ärlestig L, Rantapää-Dahlqvist S, Klareskog L, Alfredsson L, Padyukov L. OP0052 A Dense Mapping of HLA Region for Study of Interaction with Smoking in the Development of Rheumatoid Arthritis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Källberg H, Vieira V, Holmqvist M, Hart JE, Costenbader KH, Bengtsson C, Klareskog L, Karlson EW, Alfredsson L. Regional differences regarding risk of developing rheumatoid arthritis in Stockholm County, Sweden: results from the Swedish Epidemiological Investigation of Rheumatoid Arthritis (EIRA) study. Scand J Rheumatol 2013; 42:337-43. [PMID: 23611369 PMCID: PMC3815679 DOI: 10.3109/03009742.2013.769062] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Rheumatoid arthritis (RA) is a complex disease that is associated with genetic and environmental factors. We have investigated geospatial variation in the risk of developing RA within Stockholm County, Sweden, with respect to established environmental risk factors for RA, as well as serologically defined subgroups of RA. METHOD Information regarding geographical location for 1432 cases and 2529 controls from the Epidemiological Investigation of Rheumatoid Arthritis (EIRA) study, living in Stockholm County at RA symptom onset, or matched date for controls, was used to estimate geospatial variation in risk. We used generalized additive models (GAMs) to create a risk surface, calculate odds ratios (ORs), and adjust for potential confounding by smoking, education level, and RA within family. We performed a stratified analysis based on the presence/absence of anti-citrullinated peptide antibodies (ACPA). RESULTS We found significant spatial variation in the odds of developing RA in Stockholm County. After adjustment for smoking, education level, and family history of RA, this geospatial variation remained. The stratified analysis showed areas with higher ORs for ACPA-positive RA and ACPA-negative RA, after adjusting for smoking, education level, and having a family history of RA. Living in the city of Stockholm was associated with decreased risk of RA. CONCLUSIONS The risk of developing RA in Stockholm County is not distributed evenly and there are areas of increased risk that could not be explained by known factors. Further investigations of local exposures or social factors are warranted.
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Affiliation(s)
- H Källberg
- Institute of Environmental Medicine, Karolinska Institutet , Stockholm , Sweden
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Bengtsson C, Padyukov L, Källberg H, Saevarsdottir S. Thyroxin substitution and the risk of developing rheumatoid arthritis; results from the Swedish population-based EIRA study. Ann Rheum Dis 2013; 73:1096-100. [PMID: 23613482 DOI: 10.1136/annrheumdis-2013-203354] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Hypothyroidism in iodine-repleted areas is usually of autoimmune nature and leads to chronic thyroxin substitution. It shares some risk factors with anti-citrullinated peptide antibodies (ACPA)-positive rheumatoid arthritis (RA). We asked whether thyroxin substitution associated with risk of ACPA-positive or ACPA-negative RA, and whether interactions with established risk factors were present. METHODS Data from a population-based case-control study with incident RA cases were analysed (1998 adult cases, 2252 controls). Individuals reporting thyroxin substitution were compared with those without thyroxin, by calculating OR with 95% CI, excluding participants reporting non-autoimmune causes for thyroxin substitution (thyroid cancer, iodine-containing drugs). Interaction was evaluated by attributable proportion (AP) with 95% CI. RESULTS Thyroxin substitution was associated with a twofold risk of both ACPA-positive (OR=1.9, 95% CI 1.4 to 2.6) and ACPA-negative RA (OR=2.1, 95% CI 1.5 to 3.1). For ACPA-positive RA, the risk associated with the combination thyroxin+ HLA-DRB1 shared epitope alleles (SE) was much higher (OR=11.8, 95% CI 6.9 to 20.0) than for thyroxin (OR=1.4, 95% CI 0.7 to 3.0) or SE (OR=5.7, 95% CI 4.6 to 6.9) alone, indicating a strong interaction (AP=0.5, 95% CI 0.2 to 0.8). Thyroxin substitution interacted non-significantly with smoking (AP=0.4, 95% CI 0.0 to 0.7; OR thyroxin+smoking=3.6, thyroxin only=1.5, smoking only=1.8). Thyroxin did not interact with the PTPN22*R620W allele. CONCLUSIONS Thyroxin users had a doubled risk of both ACPA-positive and ACPA-negative RA. The risk of ACPA-positive RA was manifold if they smoked or carried the SE. Furthermore, although joint symptoms can be a manifestation of hypothyroidism, physicians might consider whether it could be an early manifestation of RA.
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Affiliation(s)
- Camilla Bengtsson
- Institute of Environmental Medicine, Karolinska Institutet, , Stockholm, Sweden
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Lundström E, Gustafsson JT, Jönsen A, Leonard D, Zickert A, Elvin K, Sturfelt G, Nordmark G, Bengtsson AA, Sundin U, Källberg H, Sandling JK, Syvänen AC, Klareskog L, Gunnarsson I, Rönnblom L, Padyukov L, Svenungsson E. HLA-DRB1*04/*13 alleles are associated with vascular disease and antiphospholipid antibodies in systemic lupus erythematosus. Ann Rheum Dis 2012; 72:1018-25. [PMID: 22893315 DOI: 10.1136/annrheumdis-2012-201760] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND OBJECTIVES Vascular disease is common in systemic lupus erythematosus (SLE) and patients with antiphospholipid antibodies (aPL) are at high risk to develop arterial and venous thrombosis. Since HLA class II genotypes have been linked to the presence of pro-thrombotic aPL, we investigated the relationship between HLA-DRB1 alleles, aPL and vascular events in SLE patients. METHODS 665 SLE patients of Caucasian origin and 1403 controls were included. Previous manifestations of ischaemic heart disease, ischaemic cerebrovascular disease (ICVD) and venous thromboembolism (together referred to as any vascular events (AVE)) were tabulated. aPL were measured with ELISA. Two-digit HLA-DRB1 typing was performed by sequence-specific primer-PCR. RESULTS HLA-DRB1*04 was more frequent among SLE patients with ICVD compared to unaffected patients. This association remained after adjustment for known traditional cardiovascular risk factors. HLA-DRB1*13 was associated with AVE. All measured specificities of aPL-cardiolipin IgG and IgM, β2-glycoprotein-1 IgG, prothrombin (PT) IgG and a positive lupus anticoagulant test were associated with HLA-DRB1*04-while HLA-DRB1*13 was associated with IgG antibodies (β2-glycoprotein-1, cardiolipin and PT). In patients with the combined risk alleles, HLA-DRB1*04/*13, there was a significant additive interaction for the outcomes AVE and ICVD. CONCLUSIONS The HLA-DRB1*04 and HLA-DRB1*13 alleles are associated with vascular events and an aPL positive immune-phenotype in SLE. Results demonstrate that a subset of SLE patients is genetically disposed to vascular vulnerability.
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Affiliation(s)
- Emeli Lundström
- Department of Medicine, Rheumatology Unit, Karolinska Institutet/Karolinska University Hospital, Stockholm, Sweden
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Hart JE, Källberg H, Laden F, Bellander T, Costenbader KH, Holmqvist M, Klareskog L, Alfredsson L, Karlson EW. Ambient air pollution exposures and risk of rheumatoid arthritis: results from the Swedish EIRA case-control study. Ann Rheum Dis 2012; 72:888-94. [PMID: 22833374 DOI: 10.1136/annrheumdis-2012-201587] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Environmental factors may play a role in the development of rheumatoid arthritis (RA). We examined whether long-term exposures to air pollution were associated with the risk of RA in the Swedish Epidemiological Investigation of Rheumatoid Arthritis Study. METHODS We studied 1497 incident RA cases and 2536 controls. Local levels of particulate matter (PM10) and gaseous pollutants (sulphur dioxide (SO2) and nitrogen dioxide (NO2)) from traffic and home heating were predicted for all residential addresses. We examined the association of an IQR increase (2 µg/m3 for PM10, 8 µg/m3 for SO2 and 9 µg/m3 for NO2) in each pollutant at different time points before symptom onset and average exposure with the risk of all RA and the risk of the rheumatoid factor and anti-citrullinated protein antibody (ACPA) RA phenotypes. RESULTS There was no evidence of an increased risk of RA with PM10. Total RA risks were modestly elevated for the gaseous pollutants, but were not statistically significant after adjustment for smoking and education (OR 1.18, 95% CI 0.97 to 1.43 and OR 1.09, 95% CI 0.99 to 1.19 for SO2 and NO2 in the 10th year before onset). Stronger elevated risks were observed for individuals with less than a university education and with the ACPA-negative RA phenotype. CONCLUSIONS No consistent overall associations between air pollution in the Stockholm area and the risk of RA were observed. However, there was a suggestion of increased risks of RA incidence with increases in NO2 from local traffic and SO2 from home heating sources with stronger associations for the ACPA-negative phenotype.
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Affiliation(s)
- Jaime E Hart
- Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.
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Sverdrup BM, Källberg H, Klareskog L, Alfredsson L. Usage of skin care products and risk of rheumatoid arthritis: results from the Swedish EIRA study. Arthritis Res Ther 2012; 14:R41. [PMID: 22455933 PMCID: PMC3392837 DOI: 10.1186/ar3749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Revised: 10/21/2011] [Accepted: 02/28/2012] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION The aim of this study was to investigate the association between exposure to cosmetics, often containing mineral oil, and the risk of developing rheumatoid arthritis (RA). The study was performed against the background that occupational exposure to mineral oil has recently been shown to be associated with an increased risk for RA in man, and that injection of or percutaneous exposure to mineral-oil-containing cosmetics can induce arthritis in certain rat strains. METHODS A population-based case-control study of incident cases of RA was performed among the population aged 18 to 70 years in a defined area of Sweden during May 1996 to December 2003. A case was defined as an individual from the study base, who received for the first time a diagnosis of RA according to the 1987 American College of Rheumatology criteria. Controls were randomly selected from the study base with consideration taken for age, gender and residential area. Cases (n = 1,419) and controls (n = 1,674) answered an extensive questionnaire regarding environmental and lifestyle factors including habits of cosmetic usage. The relative risk of developing RA was calculated for subjects with different cosmetic usage compared with subjects with low or no usage. Analysis was also performed stratifying the cases for presence/absence of rheumatoid factor and antibodies to citrulline-containing peptides. RESULTS The relative risks of developing RA associated with use of cosmetics were all close to one, both for women and men, for different exposure categories, and in relation to different subgroups of RA. CONCLUSION This study does not support the hypothesis that ordinary usage of common cosmetics as body lotions, skin creams, and ointments, often containing mineral oil, increase the risk for RA in the population in general. We cannot exclude, however, that these cosmetics can contribute to arthritis in individuals carrying certain genotypes or simultaneously being exposed to other arthritis-inducing environmental agents.
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Affiliation(s)
- Berit M Sverdrup
- Rheumatology Unit, Department of Medicine, Karolinska Institutet/Karolinska University Hospital, 171 76 Stockholm, Sweden.
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Ambrosi A, Salomonsson S, Eliasson H, Zeffer E, Skog A, Dzikaite V, Bergman G, Fernlund E, Tingström J, Theander E, Rydberg A, Skogh T, Öhman A, Lundström U, Mellander M, Winqvist O, Fored M, Ekbom A, Alfredsson L, Källberg H, Olsson T, Gadler F, Jonzon A, Kockum I, Sonesson SE, Wahren-Herlenius M. Development of heart block in children of SSA/SSB-autoantibody-positive women is associated with maternal age and displays a season-of-birth pattern. Ann Rheum Dis 2011; 71:334-40. [PMID: 21953338 DOI: 10.1136/annrheumdis-2011-200207] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Congenital heart block may develop in the fetuses of Ro/SSA-positive and La/SSB-positive mothers. Recurrence rates of only 10-20% despite persisting maternal antibodies indicate that additional factors are critical for the establishment of heart block. The authors investigated the influence of other maternal and fetal factors on heart block development in a Swedish population-based cohort. METHODS The influence of fetal gender, maternal age, parity and time of birth on heart block development was analysed in 145 families, including Ro/La-positive (n=190) and Ro/La-negative (n=165) pregnancies. RESULTS There was a recurrence rate of 12.1% in Ro/La-positive women, and no recurrence in Ro/La-negative women. Fetal gender and parity did not influence the development of heart block in either group. Maternal age in Ro/La-positive pregnancies with a child affected by heart block was, however, significantly higher than in pregnancies resulting in babies without heart block (p<0.05).Seasonal timing of pregnancy influenced the outcome. Gestational susceptibility weeks 18-24 occurring during January-March correlated with a higher proportion of children with heart block and lower vitamin D levels during the same period in a representative sample of Swedish women and a corresponding higher proportion of children with heart block born in the summer (p<0.02). Maternal age or seasonal timing of pregnancy did not affect the outcome in Ro/La-negative pregnancies. CONCLUSION This study identifies maternal age and seasonal timing of pregnancy as novel risk factors for heart block development in children of Ro/La-positive women. These observations may be useful for counselling when pregnancy is considered.
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Affiliation(s)
- Aurélie Ambrosi
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
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Ding B, Källberg H, Klareskog L, Padyukov L, Alfredsson L. GEIRA: gene-environment and gene-gene interaction research application. Eur J Epidemiol 2011; 26:557-61. [PMID: 21519893 PMCID: PMC3143319 DOI: 10.1007/s10654-011-9582-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Accepted: 04/07/2011] [Indexed: 11/29/2022]
Abstract
The GEIRA (Gene-Environment and Gene-Gene Interaction Research Application) algorithm and subsequent program is dedicated to genome-wide gene-environment and gene-gene interaction analysis. It implements concepts of both additive and multiplicative interaction as well as calculations based on dominant, recessive and co-dominant genetic models, respectively. Estimates of interactions are incorporated in a single table to make the output easily read. The algorithm is coded in both SAS and R. GEIRA is freely available to non-commercial users at http://www.epinet.se. Additional information, including user's manual and example datasets is available online at http://www.epinet.se.
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Affiliation(s)
- Bo Ding
- Institute of Environmental Medicine, Karolinska Institutet, SE-171 77, Box 210, Stockholm, Sweden.
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Källberg H, Ding B, Padyukov L, Bengtsson C, Rönnelid J, Klareskog L, Alfredsson L. Smoking is a major preventable risk factor for rheumatoid arthritis: estimations of risks after various exposures to cigarette smoke. Ann Rheum Dis 2010; 70:508-11. [PMID: 21149499 DOI: 10.1136/ard.2009.120899] [Citation(s) in RCA: 249] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Earlier studies have demonstrated that smoking and genetic risk factors interact in providing an increased risk of rheumatoid arthritis (RA). Less is known on how smoking contributes to RA in the context of genetic variability, and what proportion of RA may be caused by smoking. OBJECTIVES To determine the association between the amount of smoking and risk of RA in the context of different HLA-DRB1 shared epitope (SE) alleles, and to estimate proportions of RA cases attributed to smoking. DESIGN Setting and Participants Data from the Swedish Epidemiological Investigation of Rheumatoid Arthritis (EIRA) case-control study encompassing 1204 cases and 871 controls were analysed. Main Outcome Measure Estimated OR to develop RA and excess fraction of cases attributable to smoking according to the amount of smoking and genotype. RESULTS Smoking was estimated to be responsible for 35% of anticitrullinated protein/peptide antibody (ACPA)-positive cases. For each HLA-DRB1 SE genotype, smoking was dose-dependently associated with an increased risk of ACPA-positive RA (p trend <0.001). In individuals carrying two copies of the HLA-DRB1 SE, 55% of ACPA-positive RA was attributable to smoking. CONCLUSIONS Smoking is a preventable risk factor for RA. The increased risk due to smoking is dependent on the amount of smoking and genotype.
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Affiliation(s)
- Henrik Källberg
- Correspondence to Dr Henrik Källberg, Institute of Environmental Medicine, Box 210, Karolinska Institutet, 171 77 Stockholm, Sweden.
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Bengtsson C, Kapetanovic MC, Källberg H, Sverdrup B, Nordmark B, Klareskog L, Alfredsson L. Common vaccinations among adults do not increase the risk of developing rheumatoid arthritis: results from the Swedish EIRA study. Ann Rheum Dis 2010; 69:1831-3. [PMID: 20603497 DOI: 10.1136/ard.2010.129908] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the association between vaccinations in adults and the risk of developing rheumatoid arthritis (RA). METHODS Data from the Swedish population-based Epidemiological Investigation of RA case-control study encompassing 1998 incident cases of RA aged 18-70 years and 2252 randomly selected controls matched for age, sex and residency were analysed. Those vaccinated within 5 years before disease onset were compared with those not vaccinated by calculating OR with 95% CI. RESULTS Vaccinations neither increased the risk of RA overall (OR 1.0, 95% CI 0.9 to 1.1) nor the risk of two major subgroups of RA (antibodies to citrullinated peptide-positive (ACPA-positive) and ACPA-negative disease). Furthermore, vaccinations did not increase the risk of RA in smokers or carriers of HLA-DRB1 shared epitope alleles, two groups with established risk factors for RA. CONCLUSIONS In this case-control study of incident cases of newly diagnosed RA, no increased risk of RA following immunisation was observed for vaccinations overall or for any specific vaccination. This indicates that immunological provocation of adults with commonly used vaccines in their present form carries no risk of RA. These findings should be implemented among public healthcare providers in order to encourage vaccinations according to recommended national vaccination schedules.
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Affiliation(s)
- Camilla Bengtsson
- Institute of Environmental Medicine, Karolinska Institutet, Box 210, S-171 77 Stockholm, Sweden.
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Seddighzadeh M, Korotkova M, Källberg H, Ding B, Daha N, Kurreeman FAS, Toes REM, Huizinga TW, Catrina AI, Alfredsson L, Klareskog L, Padyukov L. Evidence for interaction between 5-hydroxytryptamine (serotonin) receptor 2A and MHC type II molecules in the development of rheumatoid arthritis. Eur J Hum Genet 2010; 18:821-6. [PMID: 20179740 DOI: 10.1038/ejhg.2010.12] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
It has repeatedly been suggested that the development of complex diseases can be elucidated by gene-gene interactions. Recently, we found that HTR2A, a member of the serotonin receptor family, is associated with rheumatoid arthritis (RA). This study was aimed to investigate the possibility of a gene-gene interaction between HTR2A and the major genetic risk factor for RA, HLA-DRB1 shared epitope (SE) alleles. We studied 4095 RA cases and 3223 controls from three different populations - from Sweden, the United States and the Netherlands - to test for interaction between the protective HTR2A haplotype and HLA-DRB1 SE alleles. Further, we analyzed mRNA and/or protein expression of HTR2A and HLA-DR in biopsy samples and in synovial fibroblasts from RA patients. The interaction was defined as departure from additivity of effects using attributable proportion due to interaction. First, we could demonstrate and further replicate an interaction between a protective haplotype in HTR2A and HLA-DRB1 SE alleles regarding risk of developing autoantibody-positive RA. Second, we could show that both genes are constitutively expressed in fibroblasts from synovial tissue of RA patients, and, by double immunofluorescence staining, we demonstrated that these two proteins are colocalized in these cells. In conclusion, our data demonstrate a statistical interaction between HTR2A and HLA-DRB1 SE alleles and colocalization of the product of these two genes in inflamed synovial tissue, which suggest a possible biological relationship between these two proteins. This finding may lead to the development of treatment based on enhancing the protective features of 5-HT2A in individuals with a certain HLA genotype.
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Affiliation(s)
- Maria Seddighzadeh
- Rheumatology Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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Stolt P, Yahya A, Bengtsson C, Källberg H, Rönnelid J, Lundberg I, Klareskog L, Alfredsson L. Silica exposure among male current smokers is associated with a high risk of developing ACPA-positive rheumatoid arthritis. Ann Rheum Dis 2009; 69:1072-6. [DOI: 10.1136/ard.2009.114694] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
ObjectiveTo study the association between silica exposure, separately as well as combined with smoking, and the risk of developing rheumatoid arthritis (RA) with or without the presence of antibodies against citrullinated peptide antigens (ACPA).MethodsThis Swedish population based case–control study analysed 577 incident RA cases and 659 randomly selected controls, all men aged 18–70 years, included during May 1996 to May 2006. Self-reported silica exposure, defined as exposure to stone dust, rock drilling or stone crushing and cigarette smoking was registered. ACPA status among cases was analysed.ResultsSilica-exposed subjects were found to have a moderately increased risk of ACPA-positive RA (odds ratio (OR) adjusted for age and residency=1.67 (95% CI 1.13 to 2.48), but not of ACPA-negative RA (OR=0.98 (95% CI 0.57 to 1.66)), compared with subjects unexposed to silica. Subjects exposed to rock drilling were found to have a somewhat more markedly increased risk of ACPA-positive RA (OR=2.34 (95% CI 1.17 to 4.68)). A high risk of developing ACPA-positive RA was observed among silica-exposed current smokers (OR=7.36 (95% CI 3.31 to 16.38)), exceeding the risk expected from the separate effects of silica exposure and current smoking, indicating an interaction between these exposures (attributable proportion due to interaction=0.60 (95% CI 0.26 to 0.95)).ConclusionSilica exposure combined with smoking among men is associated with an increased risk of developing ACPA-positive RA. These results suggest that different inhalation exposures may interact in the aetiology of ACPA-positive RA.
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Mahdi H, Fisher BA, Källberg H, Plant D, Malmström V, Rönnelid J, Charles P, Ding B, Alfredsson L, Padyukov L, Symmons DPM, Venables PJ, Klareskog L, Lundberg K. Specific interaction between genotype, smoking and autoimmunity to citrullinated alpha-enolase in the etiology of rheumatoid arthritis. Nat Genet 2009; 41:1319-24. [PMID: 19898480 DOI: 10.1038/ng.480] [Citation(s) in RCA: 230] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2009] [Accepted: 10/01/2009] [Indexed: 12/27/2022]
Abstract
Gene-environment associations are important in rheumatoid arthritis (RA) susceptibility, with an association existing between smoking, HLA- DRB1 'shared epitope' alleles, PTPN22 and antibodies to cyclic citrullinated peptides (CCP). Here, we test the hypothesis that a subset of the anti-CCP response, with specific autoimmunity to citrullinated alpha-enolase, accounts for an important portion of these associations. In 1,497 individuals from three RA cohorts, antibodies to the immunodominant citrullinated alpha-enolase CEP-1 epitope were detected in 43-63% of the anti-CCP-positive individuals, and this subset was preferentially linked to HLA-DRB1*04. In a case-control analysis of 1,000 affected individuals and 872 controls, the combined effect of shared epitope, PTPN22 and smoking showed the strongest association with the anti-CEP-1-positive subset (odds ratio (OR) of 37, compared to an OR of 2 for the corresponding anti-CEP-1-negative, anti-CCP-positive subset). We conclude that citrullinated alpha-enolase is a specific citrullinated autoantigen that links smoking to genetic risk factors in the development of RA.
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Affiliation(s)
- Hiba Mahdi
- Rheumatology Unit, Karolinska Institutet, Center for Molecular Medicine, Stockholm, Sweden
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Lundström E, Källberg H, Alfredsson L, Klareskog L, Padyukov L. Gene-environment interaction between the DRB1 shared epitope and smoking in the risk of anti-citrullinated protein antibody-positive rheumatoid arthritis: all alleles are important. ACTA ACUST UNITED AC 2009; 60:1597-603. [PMID: 19479873 DOI: 10.1002/art.24572] [Citation(s) in RCA: 112] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE An interaction effect for developing rheumatoid arthritis (RA) was previously observed between HLA-DRB1 shared epitope (SE) alleles and smoking. We aimed to further investigate this interaction between distinct SE alleles and smoking regarding the risk of developing RA with and without anti-citrullinated protein antibodies (ACPAs). METHODS We used data regarding smoking habits and HLA-DRB1 genotypes from 1,319 patients and 943 controls from the Epidemiological Investigation of Rheumatoid Arthritis, in which 972 patients and 488 controls were SE positive. Subsequently, 759 patients and 328 controls were subtyped for specific alleles within the DRB1*04 group. Odds ratios with 95% confidence intervals (95% CIs) were calculated by means of logistic regression. Interaction was evaluated by calculating attributable proportion due to interaction, with 95% CIs. RESULTS A strong interaction between smoking and SE alleles in the development of ACPA-positive RA was observed for all DRB1*04 SE alleles taken as a group (relative risk [RR] 8.7 [95% CI 5.7-13.1]) and for the *0401 and *0404 alleles (RR 8.9 [95% CI 5.8-13.5]) and the *01 and *10 alleles (RR 4.9 [95% CI 3.0-7.8]) as specific, separate groups, with similar strength of interaction for the different groups (attributable proportion due to interaction 0.4 [95% CI 0.2-0.6], 0.5 [95% CI 0.3-0.7], and 0.6 [95% CI 0.4-0.8], respectively). CONCLUSION There is a statistically significant interaction between distinct DRB1 SE alleles and smoking in the development of ACPA-positive RA. Interaction occurs with the *04 group as well as the *01/*10 group, demonstrating that regardless of fine specificity, all SE alleles strongly interact with smoking in conferring an increased risk of ACPA-positive RA.
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Affiliation(s)
- Emeli Lundström
- Karolinska Institutet, Rheumatology Unit, Department of Medicine, Stockholm, Sweden.
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Lundström E, Källberg H, Smolnikova M, Ding B, Rönnelid J, Alfredsson L, Klareskog L, Padyukov L. Opposing effects of HLA-DRB1*13 alleles on the risk of developing anti-citrullinated protein antibody-positive and anti-citrullinated protein antibody-negative rheumatoid arthritis. ACTA ACUST UNITED AC 2009; 60:924-30. [PMID: 19333936 DOI: 10.1002/art.24410] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The effect of non-shared epitope HLA-DRB1 alleles on rheumatoid arthritis (RA) is poorly understood. This study was undertaken to investigate the effects of several HLA-DRB1 alleles, independent of the shared epitope, on the risk of developing anti-citrullinated protein antibody (ACPA)-positive or ACPA-negative RA in a large case-control study. METHODS HLA typing for the DRB1 gene was performed in 1,352 patients with RA and 922 controls from the Swedish Epidemiological Investigation of Rheumatoid Arthritis study. Relative risks (RRs) and 95% confidence intervals (95% CIs) were calculated. RESULTS DRB1*13 was found to protect against ACPA-positive RA when stratifying for the shared epitope and using a dominant genetic model (RR 0.41 [95% CI 0.26-0.64]). Furthermore, DRB1*13 neutralized the effect of the shared epitope in ACPA-positive RA (RR 3.91 [95% CI 3.04-5.02] in patients who had the shared epitope but not DRB1*13, and RR 1.22 [95% CI 0.81-1.83] in patients with both the shared epitope and DRB1*13, as compared with patients negative for both the shared epitope and DRB1*13). However, we did not replicate the previous published risk of ACPA-negative RA conferred by DRB1*03 when a dominant genetic model was used (RR 1.29 [95% CI 0.91-1.82]). Similarly, no significant effect of DRB1*03 on RR for ACPA-negative RA was seen using the recessive genetic model (RR 1.18 [95% CI 0.6-2.4]). In contrast, the combination of DRB1*03 and DRB1*13 was significantly associated with increased risk of developing ACPA-negative RA (RR 2.07 [95% CI 1.17-3.67]). CONCLUSION Our findings indicate that the DRB1*13 allele plays a dual role in the development of RA, by protecting against ACPA-positive RA but, in combination with DRB1*03, increasing the risk of ACPA-negative RA.
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