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Original Article
Available online 5 August 2025
Survey to evaluate exposure to environmental factors in patients with rheumatoid arthritis
Encuesta para evaluar la exposición a los factores ambientales en los pacientes con artritis reumatoide
Alexandra Zúñigaa, Alba Luz León Álvareza, Luisa Carbal-Reyesa, Daniel Rodríguezb, Juan-Camilo Díazb, Gloria Vásqueza, Diana Castañoa,
a Grupo de Inmunología Celular e Inmunogenética, Instituto de Investigaciones Médicas, Facultad de Medicina, Universidad de Antioquia (UDEA), Medellín, Colombia
b Artmédica S.A.S, Medellín, Colombia
Received 22 May 2024. Accepted 05 June 2025
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Tables (6)
Table 1. Published studies evaluating the association between different environmental factors and the development of RA.
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Table 2. Dimensions and number of items investigated in the survey.
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Table 3. Survey to assess exposure to environmental factors in patients with rheumatoid arthritis.
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Table 4. Selection criteria of experts.
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Table 5. Results of Kendall's W coefficient of agreement between experts for the assessment categories of sufficiency, coherence, relevance, and clarity.
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Table 6. Dimensions assessed in the 30 pilot test participants.
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Abstract
Introduction and aims

This study develops and validates an instrument to investigate and identify environmental factors associated with rheumatoid arthritis (RA), in order to improve the understanding of potential triggers.

Methods

Using an exhaustive review of the literature and the involvement of a panel of rheumatology experts, a survey was designed based mainly on environmental exposures that covered various dimensions. The distribution of the evaluated categories was assessed to determine their sufficiency, coherence, relevance, and clarity by Kruskal-Wallis test, Kendall’s W for concordance, and finally, it was subjected to content validation by experts and underwent pilot testing.

Results

The survey consisted of 89 items total divided in 7 dimensions (sociodemographic aspects, consumables –cigarette–, other consumables, occupational or pollutants, previous diagnoses, other factors, and questions for potential cases). The assessment conducted by the experts showed a high concordance among them with values between 0.76 and 0.96. The pilot test demonstrated that the survey can be satisfactorily applied to Spanish-speaking people with different levels of education.

Discussion and conclusions

The created and validated instrument offers a solid tool adapted to the Latin American culture to investigate environmental factors associated with RA. Its development contributes to filling a gap in the scientific literature and highlights the importance of considering these factors in the understanding and intervention of the disease, both in patients with RA and individuals at potential risk of developing this disease.

Keywords:
Rheumatoid arthritis
Environmental factors
Risk factor
Protective factor
Tobacco
Smoking
Occupational exposure
Survey
Resumen
Introducción y objetivos

Este estudio desarrolla y valida un instrumento para indagar e identificar factores ambientales asociados con la artritis reumatoide (AR), con el fin de mejorar la comprensión de sus posibles desencadenantes.

Métodos

A través de una revisión exhaustiva de la literatura y la participación de un panel de expertos en reumatología, se construyó una encuesta basada principalmente en exposiciones ambientales que abarcó diversas dimensiones. Se evaluó la distribución de las categorías evaluadas para determinar su suficiencia, coherencia, relevancia y claridad a través de la prueba Kruskal-Wallis, la concordancia con W de Kendall y finalmente fue sometida a validación de contenido por expertos y prueba piloto.

Resultados

La encuesta quedo conformada por un total de 89 ítems dividido en 7 dimensiones (aspectos sociodemográficos, consumibles –cigarrillo–, otros consumibles, ocupacionales o contaminantes, diagnósticos previos, otros factores y preguntas para potenciales casos). La valoración realizada por los expertos mostró una alta concordancia entre ellos con valores entre 0,76 y 0,96. La prueba piloto demostró que la encuesta puede ser aplicada de forma satisfactoria a personas de habla hispana con diferentes niveles de educación.

Discusión y conclusiones

El instrumento creado y validado ofrece una herramienta sólida y adaptada a la cultura latinoamericana para investigar factores ambientales asociados con AR. Su desarrollo contribuye a llenar un vacío en la literatura científica y resalta la importancia de considerar estos factores relevantes en la comprensión e intervención de la enfermedad, tanto en pacientes con AR como en individuos en potencial riesgo de desarrollar esta enfermedad.

Palabras clave:
Artritis reumatoide
Factores ambientales
Factor de riesgo
Factor protector
Cigarrillo
Fumar
Exposición ocupacional
Encuesta

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