{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,15]],"date-time":"2026-02-15T06:07:47Z","timestamp":1771135667388,"version":"3.50.1"},"reference-count":33,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T00:00:00Z","timestamp":1766102400000},"content-version":"vor","delay-in-days":18,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J of Rheum Dis"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Humidifier disinfectants (HDs) containing polyhexamethylene guanidine\/oligo(2\u2010(2\u2010ethoxy)ethoxyethyl)guanidinium chloride (PHMG\/PGH) have a strong association with interstitial lung disease (ILD). Whether PHMG\/PGH increases seropositive rheumatoid arthritis (RA) or interacts with RA to raise ILD risk is unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We constructed a registry\u2010linked retrospective cohort by linking HD\u2010claimant from the Korean Environmental Industry &amp; Technology Institute (KEITI) to the National Health Insurance Service. Individuals who were aged \u2265\u200920\u2009years as of January 1, 2003, were followed until death or December 31, 2021. PHMG\/PGH exposure was modeled time\u2010varyingly (pre vs. post). Seropositive RA (ICD\u201010\u2009M05) was identified through claims screening with medical record review; ILD was defined by J84 claims. RA incidence was estimated using Poisson regression. For ILD, we applied time\u2010dependent Cox models for PHMG\/PGH exposure and post\u2010RA status, adjusting for demographics, smoking, residence, and other HD components. Additive interaction was quantified by the relative excess risk due to interaction (RERI), attributable proportion (AP), and synergy index (\n                      <jats:italic>S<\/jats:italic>\n                      ).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Total 3452 adults (mean follow\u2010up 15.9\u2009\u00b1\u20095.6 person\u2010years) were analyzed; 1.7% developed seropositive RA and 21.6% ILD. RA incidence was 0.830 before exposure and 1.105 after (per 1000 person\u2010years;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.61). ILD hazards were elevated for PHMG\/PGH exposure (HR 3.62, 95% CI 3.11\u20134.20) and for seropositive RA (HR 3.80, 2.70\u20135.34). Co\u2010occurrence was observed more\u2010than\u2010additive risk: RERI 1.467 (95% CI 0.814\u20132.120), AP 0.143 (0.079\u20130.206),\n                      <jats:italic>S<\/jats:italic>\n                      1.188 (1.049\u20131.326).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>PHMG\/PGH exposure was not associated with increased incidence of seropositive RA. PHMG\/PGH and seropositive RA each independently raised ILD risk, with more\u2010than\u2010additive association when combined. Given the retrospective, internally compared design, mechanistic work is warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1756-185x.70510","type":"journal-article","created":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T12:44:36Z","timestamp":1766148276000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Seropositive Rheumatoid Arthritis and Polyhexamethylene Guanidine\/Oligo(2\u2010(2\u2010Ethoxy)ethoxyethyl)guanidinium Chloride Exposure Are Associated With a Synergistic Effect on the Risk of Developing Interstitial Lung Disease: Registry Based Cohort\u2010Study"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2040-389X","authenticated-orcid":false,"given":"Hyowon","family":"Choi","sequence":"first","affiliation":[{"name":"Department of Prevention Medicine Yonsei University Wonju College of Medicine  Wonju Republic of Korea"},{"name":"Huraypositive  Seoul Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0233-4269","authenticated-orcid":false,"given":"Seungjun","family":"Ryu","sequence":"additional","affiliation":[{"name":"Department of Occupational and Environmental Medicine Wonju Severance Christian Hospital  Wonju Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0039-069X","authenticated-orcid":false,"given":"Yeon\u2010Soon","family":"Ahn","sequence":"additional","affiliation":[{"name":"Department of Prevention Medicine Yonsei University Wonju College of Medicine  Wonju Republic of 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