SAT0046 ARE SENSE OF SOCIAL SUPPORT AND LOW DECISION LATITUDE AT WORK LINKED TO RISK OF RHEUMATOID ARTHRITIS, AND IF SO, HOW DO THEY RELATE TO OTHER RISK FACTORS? RESULTS FROM THE SWEDISH EIRA STUDY
Authors: Louise Hedenstierna, Christina H. Opava, Sofia Ernestam, Johan Askling, Lars Klareskog, Lars Alfredsson, Saedis Saevarsdottir
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> The role of psycho-social factors in the development of rheumatoid arthritis (RA) is debated. <h3>Objectives:</h3> We investigated whether psychosocial stress measured as low sense of social support, and low decision latitude at work, were linked to risk of RA, and whether they related to known lifestyle risk factors for RA. <h3>Methods:</h3> The Swedish population-based EIRA study included incident RA cases (N=3724) and controls (N=5937), matched for age, sex and residential area. Responders filled in questionnaires regarding self-reported social support, decision latitude at work and life-style-factors. The distribution of answers among controls were used to define exposure, thus for social support, those in the lowest quartile of social support were considered exposed to low social support and similarly for decision latitude, those in the lowest quartile were considered exposed to low decision latitude at work. Using logistic regression, we first evaluated whether exposures associated with RA risk, considering potential confounding of established risk factors. Then, we investigated whether the frequency of those factors differed between individuals reporting low social support or low decision latitude at work or not, among cases and controls. <h3>Results:</h3> There were 898 cases with low social support and 285 cases with low decision latitude at work (latter only available in first part of EIRA). Low social support was not associated with RA risk in unadjusted analyses (OR= 1.05, 95%CI=0.95-1.15). Low decision latitude at work did associate with a higher RA risk in the unadjusted analyses (OR=1.52, 95% CI=1.20-1.94), but this association was no longer significant after further adjustment for smoking, obesity and university degree (adjusted OR=1.24, 95% CI=0.93-1.63). Associations between those life-style risk factors and RA were confirmed (no university degree, OR=1.50; smoking OR=1.71; obesity OR=1.15). Next, we evaluated whether low social support or low decision latitude at work differed by previously established risk factors. Cases with RA reporting low sense of social support were more often men (OR=1.60, 95%CI=1.40-1.83), current smokers (OR=1.46, 95%CI=1.26-1.70), obese (OR=1.29, 95%CI=1.09-1.54), physically inactive (OR=2.78, 95%CI=1.98-3.90) and without a university-degree (OR=2.04, 95%CI=1.77-2.36); with similar pattern among the controls. For working-conditions, cases reporting low decision latitude at work were also more often current smokers (OR=2.05, 95%CI=1.33-3.16) and with no university degree (OR=8.23, 95%CI=5.13-13.22), but less often male (OR = 0.40, 95%CI=0.26-0.60). Again, the pattern was similar among controls. RF/ACPA-positivity did not associate with low social support or low decision latitude. <h3>Conclusion:</h3> Neither low social support nor low decision latitude at work were associated with an increased risk of RA after adjustment for other known lifestyle risk factors for RA. An initial crude association between low decision latitude at work and risk for RA was explained by differences in smoking and educational level. However, both low social support and low decision latitude at work associate strongly with known, and here validated, risk factors for RA (smoking, obesity, no university degree) with similar pattern among both cases and controls. <h3>Acknowledgement:</h3> The EIRA study group <h3>Disclosure of Interests:</h3> Louise Hedenstierna: None declared, Christina H. Opava: None declared, Sofia Ernestam: None declared, Johan Askling Grant/research support from: Karolinska Institutet (JA) has or has had research agreements with the following pharmaceutical companies, mainly in the context of the ATRIS national safety monitoring programme for rheumatology biologicals: Abbvie, BMS, MSD, Eli Lilly, Pfizer, Roche, Samsung Bioepis, and UCB., Consultant for: Karolinska Institutet has received remuneration for JA participating in ad boards arranged by Lilly, Novartis, and Pfizer., Lars Klareskog Grant/research support from: Yes, but not for the presented study., Lars Alfredsson: None declared, Saedis Saevarsdottir Employee of: Part-time employee at deCODE Genetics/Amgen Inc, working on genetic research unrelated to this project.