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Among these, 493 RA cases (301 seropositive and 192 seronegative) were validated. We estimated hazard ratios (HRs) for RA comparing those with and without familial RA\/lupus, adjusting for environmental factors (smoking, alcohol, body mass index [BMI], parity, breastfeeding, menopause, hormone use, early menarche, and menstrual regularity) using Cox proportional hazards models. Population attributable risks (PARs) for RA within this cohort were calculated for familial RA\/lupus, smoking, alcohol, BMI, parity, and breastfeeding.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Familial RA\/lupus was significantly associated with RA (HR 3.67), seropositive RA (HR 3.90), and seronegative RA (HR 3.95). After adjusting for environmental factors, familial RA\/lupus was significantly associated with RA (HR 3.59, 95% confidence interval 2.94\u20134.37). Smoking &gt;10 pack\u2010years, overweight, BMI, and premenopause status remained significantly associated with RA after adjusting for familial RA\/lupus. For RA in this cohort, the PAR for smoking, BMI, alcohol, parity, or breastfeeding collectively was 41%; the PAR due to heredity from familial RA\/lupus was 21%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In this large, prospective cohort, women with familial RA\/lupus had a 4\u2010fold increased risk for RA that remained significant after adjusting for environmental factors. A large proportion of RA risk was attributable to environmental factors, even among those with familial RA\/lupus.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acr.22366","type":"journal-article","created":{"date-parts":[[2014,8,7]],"date-time":"2014-08-07T09:41:01Z","timestamp":1407404461000},"page":"1438-1446","source":"Crossref","is-referenced-by-count":55,"title":["Contributions of Familial Rheumatoid Arthritis or Lupus and Environmental Factors to Risk of Rheumatoid Arthritis in Women: A Prospective Cohort Study"],"prefix":"10.1002","volume":"66","author":[{"given":"Jeffrey A.","family":"Sparks","sequence":"first","affiliation":[{"name":"Brigham and Women's Hospital Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chia\u2010Yen","family":"Chen","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda 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