Coffee consumption, rheumatoid factor, and the risk of rheumatoid arthritis.
BACKGROUND
Recent epidemiological studies have suggested that smoking is a risk factor for rheumatoid factor (RF) positive rheumatoid arthritis (RA). Being overweight, high serum cholesterol, and dietary factors have in some studies been found to be associated with the risk of RA. No attention, however, has been paid to coffee consumption as a risk determinant, though it is a shared covariate of the alleged risk factors.


OBJECTIVE
This study aimed at examining coffee consumption for its associations with RF positivity and with the risk of RA.


METHODS
Coffee consumption was studied, firstly, for its association with RF (sensitised sheep cell agglutination titre >/=128) in a cross sectional survey of 6809 subjects with no clinical arthritis, and secondly, for its prediction of RA in a cohort of 18 981 men and women who had neither arthritis nor a history of it at the baseline examination in 1973-76. Up to late 1989, 126 subjects of the cohort study had developed RA, of whom, 89 were positive for RF by the time of diagnosis.


RESULTS
In the cross sectional survey the number of cups of coffee drunk daily was directly proportional to the prevalence of RF positivity. Adjusted for age and sex this association was significant (p value for linear trend, 0.008), but after further adjustment for smoking the linear trend declined below significance (p=0.06). In the cohort study there was an association between coffee consumption and the risk of RF positive RA that was not due to age, sex, level of education, smoking, alcohol intake, body mass index, or serum cholesterol. After adjustment for these potential confounders the users of four or more cups a day still had a relative risk of 2.20 (95% confidence interval 1.13 to 4.27) for developing RF positive RA compared with those drinking less. Coffee consumption did not predict the development of RF negative RA.


CONCLUSIONS
Coffee consumption may be a risk factor for RA, possibly through mechanisms contributing to the production of RF. This hypothesis remains to be tested in further studies.
National Public Health Institute, Helsinki, Finland. markku.heliovaara@ktl.fi
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Heliövaara
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Aho
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Knekt
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Impivaara
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Reunanen
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Aromaa
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000009:adverse effects; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000209:etiology* / Q000276:immunology; D015992:Body Mass Index; D008078:Cholesterol, LDL / Q000097:blood; D003069:Coffee / Q000009:adverse effects*; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012217:Rheumatoid Factor / Q000032:analysis*; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects
D008078:Cholesterol, LDL; D003069:Coffee; D012217:Rheumatoid Factor