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We know that there is an association between more physical labour and AS but this hasn't been looked at in RA up until now. Many have hypothesized that stress to the joints may affect the development of arthritis. P Zeng from Sweden investigated whether repetitive prolonged physical workload is associated with increased risk for developing RA (#OP 0241).
This study used data from the Swedish Epidemiological Investigation of RA (EIRA) which is a population-based case control study with 3680 incident RA cases and almost 6000 controls. They looked at what they call repetitive prolonged physical workload (RPPW) of various types. They also assessed ACPA status and HLA-DRB1 and they controlled for potential confounders such as age, sex, residential area, smoking, alcohol, BMI and education.
They found that the odds ratio for developing RA varied from 1.3 to 1.8 with the various RPPWs. There was no difference whether patients were ACPA positive or negative, but there was an association between RRPWs and HLA-DRB1 in ACPA positive patients.
Patients using their arms above shoulder level, bending or turning or lifting or carrying more than 19 kg were at the highest risk so it might be worthwhile for us to consider type of work in patients presenting with arthralgia, early inflammatory arthritis or even family members at high risk.
We may have to do our own occupational therapy!
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About the Author
Dr. Cathy Flanagan
Cathy Flanagan, MD, FRCP(C) studied medicine at McGill University then completed fellowships in Internal Medicine and Rheumatology. She has been a Consultant in the Department of Internal Medicine at the Royal Columbian Hospital since 2000 and a Clinical Professor at the University of British Columbia since 2009.
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