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Occupational exposure to textile dust increases the risk of rheumatoid arthritis: results from a Malaysian population-based case–control study
  1. Chun Lai Too1,2,
  2. Nor Asiah Muhamad1,
  3. Anna Ilar3,
  4. Leonid Padyukov2,
  5. Lars Alfredsson3,
  6. Lars Klareskog2,
  7. Shahnaz Murad1,
  8. Camilla Bengtsson3,
  9. MyEIRA Study Group
    1. 1Institute for Medical Research, Jalan Pahang, Kuala Lumpur, Malaysia
    2. 2Rheumatology Unit, Department of Medicine, Center for Molecular Medicine L8:O4, Karolinska University Hospital, Stockholm, Sweden
    3. 3Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
    1. Correspondence to Dr Chun Lai Too Allergy and Immunology Research Center, Institute for Medical Research, Jalan Pahang, 50588 Kuala Lumpur, Malaysia; toocl{at}, chunlai.too{at}; and Dr Camilla Bengtsson, Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, Box 210, 17177 Stockholm, Sweden; camilla.bengtsson{at}


    Objectives Lung exposures including cigarette smoking and silica exposure are associated with the risk of rheumatoid arthritis (RA). We investigated the association between textile dust exposure and the risk of RA in the Malaysian population, with a focus on women who rarely smoke.

    Methods Data from the Malaysian Epidemiological Investigation of Rheumatoid Arthritis population-based case–control study involving 910 female early RA cases and 910 female age-matched controls were analysed. Self-reported information on ever/never occupationally exposed to textile dust was used to estimate the risk of developing anti-citrullinated protein antibody (ACPA)-positive and ACPA-negative RA. Interaction between textile dust and the human leucocyte antigen DR β-1 (HLA-DRB1) shared epitope (SE) was evaluated by calculating the attributable proportion due to interaction (AP), with 95% CI.

    Results Occupational exposure to textile dust was significantly associated with an increased risk of developing RA in the Malaysian female population (OR 2.8, 95% CI 1.6 to 5.2). The association between occupational exposure to textile dust and risk of RA was uniformly observed for the ACPA-positive RA (OR 2.5, 95% CI 1.3 to 4.8) and ACPA-negative RA (OR 3.5, 95% CI 1.7 to 7.0) subsets, respectively. We observed a significant interaction between exposure to occupational textile dust and HLA-DRB1 SE alleles regarding the risk of ACPA-positive RA (OR for double exposed: 39.1, 95% CI 5.1 to 297.5; AP: 0.8, 95% CI 0.5 to 1.2).

    Conclusions This is the first study demonstrating that textile dust exposure is associated with an increased risk for RA. In addition, a gene–environment interaction between HLA-DRB1 SE and textile dust exposure provides a high risk for ACPA-positive RA.

    • Rheumatoid Arthritis
    • Epidemiology
    • Ant-CCP

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