Dr. Howard has received consultant fees and speaking fees (less than $10,000) and research support in the form of drug donation from Merck/Schering-Plough.
Insecticide use and risk of rheumatoid arthritis and systemic lupus erythematosus in the Women's Health Initiative Observational Study
Article first published online: 28 JAN 2011
Copyright © 2011 by the American College of Rheumatology
Arthritis Care & Research
Volume 63, Issue 2, pages 184–194, February 2011
How to Cite
Parks, C. G., Walitt, B. T., Pettinger, M., Chen, J.-C., de Roos, A. J., Hunt, J., Sarto, G. and Howard, B. V. (2011), Insecticide use and risk of rheumatoid arthritis and systemic lupus erythematosus in the Women's Health Initiative Observational Study. Arthritis Care Res, 63: 184–194. doi: 10.1002/acr.20335
- Issue published online: 28 JAN 2011
- Article first published online: 28 JAN 2011
- Accepted manuscript online: 25 AUG 2010 03:01PM EST
- Manuscript Accepted: 18 AUG 2010
- Manuscript Received: 27 APR 2010
- Intramural Research Program of the NIH
- National Institute of Environmental Health Sciences
- National Heart, Lung, and Blood Institute
- US Department of Health and Human Services. Grant Numbers: N01-WH-22110, 24152, 32100-2, 32105-6, 32108-9, 32111-13, 32115, 32118-32119, 32122, 42107-26, 42129-32, 44221
Farming and agricultural pesticide use has been associated with 2 autoimmune rheumatic diseases, rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). However, risk associated with other residential or work place insecticide use is unknown.
We analyzed data from the Women's Health Initiative Observational Study (n = 76,861 postmenopausal women, ages 50–79 years). Incident cases (n = 213: 178 for RA, 27 for SLE, and 8 for both) were identified based on self-report and use of disease-modifying antirheumatic drugs at year 3 of followup. We examined self-reported residential or work place insecticide use (personally mixing/applying by self and application by others) in relation to RA/SLE risk, overall and in relation to farm history. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) were adjusted for age, race, region, education, occupation, smoking, reproductive factors, asthma, other autoimmune diseases, and comorbidities.
Compared with never used, personal use of insecticides was associated with increased RA/SLE risk, with significant trends for greater frequency (HR 2.04, 95% CI 1.17–3.56 for ≥6 times/year) and duration (HR 1.97, 95% CI 1.20–3.23 for ≥20 years). Risk was also associated with long-term insecticide application by others (HR 1.85, 95% CI 1.07–3.20 for ≥20 years) and frequent application by others among women with a farm history (HR 2.73, 95% CI 1.10–6.78 for ≥6 times/year).
These results suggest residential and work place insecticide exposure is associated with the risk of autoimmune rheumatic diseases in postmenopausal women. Although these findings require replication in other populations, they support a role for environmental pesticide exposure in the development of autoimmune rheumatic diseases.