Nongenetic Host Factors: Other
There have been a number of studies looking at other comorbidities that have an increased frequency in both subjects with RA and in their families. The most widely investigated has been the occurrence of other autoimmune diseases, particularly type 1 or insulin-dependent diabetes and autoimmune thyroid disease . Other diseases, for example schizophrenia, have been shown to be negatively associated with RA development . The significance of these findings is unclear.
There have been relatively few studies on anthropometric factors associated with RA, although one recent casecontrol study suggested that people who were obese were at higher risk . The reason for this is unclear, and it is not certain whether this may represent a confounding factor of another exposure or whether people who are obese have, for example, increased production of oestrogens, which might pose a risk. A more recent casecontrol study found, however, after adjusting for age, smoking and marital status, that a link with obesity was nonsignificant .
Nongenetic Host Factors: Hormonal And Pregnancy Factors
The increased risk of RA in females has lead to considerable effort in examining the role of hormonal and pregnancy factors in disease occurrence. In general, male sex hormones, particularly testosterone, are lower in men who have RA . By contrast, levels of female sex hormones are not different between RA cases and controls .
Interestingly, exogenous hormonal influences are implicated in disease risk. The most widely studied of these is exposure to the oral contraceptive pill, based on an observation made over 20 years ago . There have been several studies confirming that women who take the oral contraceptive pill are at reduced risk of developing RA . There is no clear explanation for this and the association exists despite the formulation of the oral contraceptive pill varying enormously both between populations and over time. A follow-up of the original study was undertaken that suggested the oral contraceptive pill was protective. This showed that the initial protection was lost on follow-up . One conclusion might therefore be that oral contraceptive use may postpone, rather than totally protect against, the development of RA.
Figure 2
The incidence of rheumatoid arthritis in relation to use of the oral contraceptive pill . Data from the Royal College of General Practioners’ oral contraception study .
Figure 3
Increased risk of rheumatoid arthritis onset in the postpartum period. * Relative to nonpregnant periods. Data from .
How Is Rheumatoid Arthritis Diagnosed
If you start having symptoms of rheumatoid arthritis, its a good idea to make an appointment with your doctor. A physician will be able to evaluate your symptoms to make the proper diagnosis. Your physician may conduct a series of tests and refer you to a rheumatologist, which is a physician who specializes in conditions affecting the musculoskeletal system.
Tests are the most conclusive way to determine whether your symptoms are the result of rheumatoid arthritis. Blood tests are used to evaluate the levels of immune system cells and proteins, like erythrocytes, C-reactive protein, and anti-cyclic citrullinated peptide antibodies. Elevated levels of these particles indicate high levels of inflammation throughout the body that are characteristic of rheumatoid arthritis.
In addition to blood tests, medical imaging is a useful tool for diagnosing rheumatoid arthritis. Magnetic resonance imaging , computed tomography scans, x-rays, and ultrasounds can be used to depict any structural malformations resulting from joint inflammation.
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Related Articles And Topics:
TNF-Alpha: Higher innate levels of this inflammatory cytokineDo you feel like you are always dealing with inflammation? Joint pain, food sensitivity, etc? Perhaps you are genetically geared towards a higher inflammatory response. Tumor necrosis factor is an inflammatory cytokine that acts as a signaling molecule in our immune system.
HLA-B27: Increased risk of autoimmune diseasesOur immune system does an awesome job of fighting off pathogenic bacteria and viruses. But to fight off these pathogens, the body needs to know that they are the bad guys. This is where the HLA system comes in.
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Stress Can Make Symptoms Worse
If youre stressed to the max, your body knows it. RA often develops or gets worse following periods of emotional upset, suggesting stress may be a trigger for flares as well as onsets. RA sufferers can vouch for the connection: In one study, 86 percent of patients blamed their joint symptoms on stress.
The relationship between persistent stress and chronic inflammation goes beyond rheumatoid arthritis. Some research suggests that autoimmune diseases may be more common among those diagnosed with stress disorders such as PTSD.
Good news/bad news: To the extent you can control stress in your life, you may be able to lower your risk of RA, as well as your odds of a flare. Of course, getting rid of the 21st centurys version of a common cold is easier said than done. Plentiful sleep, deep breathing exercises, and mindful meditation are all solid starting points.
No matter what caused your RA, if you have it, you have to learn to cope. We’ve got all the details on RA treatment to help you do just that – check it out here.
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Can Genetic Markers Be Used To Predict How Severe Someones Rheumatoid Arthritis Will Be
One way of looking at the severity of someones RA is to look at how much damage shows up on x-rays taken of their hands and feet. A recent study, using x-ray, in 325 Icelandic people with RA showed that a persons genes are very important in determining how much damage they have, but studies looking into this issue are in their relativeinfancy. This is because, in order to look for genetic markers that predict this damage, you need to have genetic information on large groups of people and they would also need to have had regular x-rays performed over time. Although patient groups like this are relatively scarce, researchers have had some success in identifying genetic markers associated with damage shown on x-rays. As with genetic markers associated with treatment response, much more work is needed in this important area.
How Is Ra Diagnosed
RA is diagnosed by reviewing symptoms, conducting a physical examination, and doing X-rays and lab tests. Its best to diagnose RA earlywithin 6 months of the onset of symptomsso that people with the disease can begin treatment to slow or stop disease progression . Diagnosis and effective treatments, particularly treatment to suppress or control inflammation, can help reduce the damaging effects of RA.
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Is Rheumatoid Arthritis Actually Hereditary
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Genetic Susceptibility To Ra
For starters, it helps to understand a little bit about the disease we are dealing with. RA is an autoimmune disease meaning the bodys immune system mistakenly attacks the membranes that line healthy joints. The result is inflammation and pain in the joints, which can sometimes affect other bodily systems.
The exact cause of this mistaken attack by the immune system is still not clear but, as with other autoimmune diseases, researchers do think that some people may be genetically more susceptible. This means that it is theoretically possible to pass genes to your children that could make them potentially more susceptible. But it is important to remember that it does not mean they will necessarily develop RA.
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Is Rheumatoid Arthritis Genetic
As if you needed another reason to begrudge the fam: Studies confirm that genetics increase your risk of developing the disease. The inheritance pattern is not totally clear but having a close relative with RA ups your odds of getting it, too. One study found that if your parent, sibling, or child has RA, your likelihood of the disease increases threefold.
Studies of twins offer further evidence. If one identical twin has RA, the other has a 15% chance of developing it as well. For nonidentical twins, the chance is 4%. Given less than 1% of the overall population has RA, the genetic connection is pretty clear.
Which genes, though, is less obvious. Human leukocyte antigen genes are believed to play a role, especially HLA-DRB1. These genes help the immune system tell the difference between the bodys own proteins and those from foreign invaders like viruses and bacteria. Research suggests several versions of the HLA-DRB1 gene are associated with RA risk, and more than 80% of RA patients have at least one of them. Other genes linked to RA include PTPN22, STAT4, CTLA4, TRAF1, and C5.
Scientists believe that heritability accounts for about 20 to 50% of your odds of getting RA. As for the other 50 to 80%, researchers have turned their attention to environmental and behavioral factors.
What Is Rheumatoid Arthritis Again
Rheumatoid arthritis is the second most-common type of arthritis. It affects about 1.3 million people in the United States, 70% of whom are women, according to the Arthritis Foundation. RA primarily attacks your joints but it can also affect other areas of your body. The disease typically develops between ages 40 and 60, although it may also occur in children via a condition called juvenile idiopathic arthritis.
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What If A Family Member Has Rheumatoid Arthritis
A study found that the first-degree relatives of a person who has rheumatoid arthritis are nearly three times more likely to develop the disease as compared to the first degree relatives of people without rheumatoid arthritis.14 This means that children, parents, and siblings of a person with rheumatoid arthritis are at a slightly higher risk of developing the illness. However, this risk does not take into account any environmental factors.
Another study reported that genetic factors account for almost 52 to 67 percent of all the causes of rheumatoid arthritis.15 This estimated percentage was calculated by observing twins, especially identical twins who have the exact same genes. In fact, studies carried out on twins found further evidence that genes do contribute to the risk of developing rheumatoid arthritis.16 Identical twins share 100 percent of their genes, and it is more likely that both twins will have rheumatoid arthritis as compared to non-identical twins, who only share 50% of their genes.
The study found that both the twins had rheumatoid arthritis in 15 percent of the participating sets of identical twins in the study, while just four percent of non-identical twins had rheumatoid arthritis.17
Managing Rheumatoid Arthritis With Lifestyle And Diet
When used alongside a medical treatment plan, lifestyle and diet changes can be a crucial part of decreasing the frequency of arthritis flare-ups and managing symptoms. Here are some tips for making lifestyle and diet changes that support relief from rheumatoid arthritis symptoms.
1. Eat Plenty of Fruits and Vegetables
Fruits and vegetables are some of natures most potent healing foods. Eating an abundance of fruits and vegetables helps to support a healthy immune response. Fruits and veggies are filled with micronutrients like vitamins, minerals, and antioxidants that help the cells throughout your body function as efficiently as possible.
2. Make Fatty Fish a Regular Part of Your Diet
Why is fatty fish good for you? Because its packed with healthy fats called omega-3 fatty acids. Omega-3 fatty acids are a type of polyunsaturated fat that helps improve the immune system response and lower inflammation throughout the body. Omega-3 fatty acids have been shown to be effective for supporting healing for a variety of other diseases, including fatty liver disease and type 2 diabetes. Fish that are particularly rich in omega-3 fatty acids include salmon, mackerel, sardines, and Arctic char.
Having trouble incorporating fish into your diet on a regular basis? Supplements can make up for that. Just make sure you find a high-quality supplement that provides pure fish oil so that youre not intaking a lot of additives and impurities.
3. Get High-Quality Protein
4. Get Vitamin D
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Who Should Diagnose And Treat Ra
A doctor or a team of doctors who specialize in care of RA patients should diagnose and treat RA. This is especially important because the signs and symptoms of RA are not specific and can look like signs and symptoms of other inflammatory joint diseases. Doctors who specialize in arthritis are called rheumatologists, and they can make the correct diagnosis. To find a provider near you, visit the database of rheumatologistsexternal icon on the American College of Rheumatology website.
How Is Juvenile Idiopathic Arthritis Diagnosed
Diagnosing JIA may be difficult. There is no single test to confirm the disease. Your childs healthcare provider will take your childs health history and do a physical exam. Your child’s provider will ask about your child’s symptoms, and any recent illness. JIA is based on symptoms of inflammation that have occurred for 6 weeks or more.
Tests may also be done. These include blood tests such as:
Your child may also have imaging tests. These can show how much damage the bones have. The tests may include:
- X-rays. This test uses a small amount of radiation to make images of organs, bones, and other tissues.
- CT scan. This uses a series of X-rays and a computer to make detailed images of bones, muscles, fat, and organs. CT scans are more detailed than regular X-rays.
- MRI. This test uses large magnets and a computer to make detailed pictures of organs and structures in the body.
- Bone scan. This uses a small amount of radiation to highlight the bones in a scanner.
Other tests may include:
- Urine tests. These look for blood or protein in the urine. This can mean the kidneys are not working normally.
- Joint aspiration . A small sample of the synovial fluid is taken from a joint. It’s tested to see if crystals, bacteria, or viruses are present.
- Full eye exam done by an ophthalmologist
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How Is Juvenile Idiopathic Arthritis Treated
The goal of treatment is to reduce pain and stiffness, and help your child keep as normal a lifestyle as possible.
Treatment will depend on your childs symptoms, age, and general health. It will also depend on how severe the condition is.
Treatment may include medicines such as:
- Nonsteroidal anti-inflammatory medicines , to reduce pain and inflammation
- Disease-modifying antirheumatic medicines , such as methotrexate, to ease inflammation and control JIA
- Corticosteroid medicines, to reduce inflammation and severe symptoms
- Medicines called biologics that interfere with the body’s inflammatory response. They are used if other treatment isnt working.
Talk with your childs healthcare provider about the risks, benefits, and possible side effects of all medicines.
Other treatments and lifestyle changes may include:
- Physical therapy, to improve and maintain muscle and joint function
- Occupational therapy, to improve ability to do activities of daily living
- Nutrition counseling
- Regular eye exams to find early eye changes from inflammation
- Regular exercise and weight control
- Getting enough rest
- Learning to use large joints instead of small joints to move or carry things
Family History And Genetics
If you have a close relative with RA, you are at an increased risk of developing the condition. Some research estimates that genetics make up about 60% of the risk. However, it’s not as simple as “my mom had it so I’ll have it.” Instead, one or both of your parents may have had a particular genetic makeup that put them at-risk for RA, and they may have passed that risk on to you.
It generally takes more than genetics to trigger RA, though. Environmental and lifestyle factors contribute, as well. Certain infections, injury, long-term cigarette smoking, exposure to certain dusts or fibers, obesity, stress, and many more factors, when combined with genetics, may up the odds of RA developing in you. .
More than 100 genes are linked to or suspected of being linked to RA. The most significant ones are variations of human leukocyte antigen genes. Those genes produce proteins that help the immune system tell different kinds of cells apartspecifically, distinguishing viruses, bacteria, and other foreign invaders from healthy cells.
Along with HLA genes, some of the genetic markers known to increase the risk of developing RA include:
- STAT4: Helps regulate and activate the immune system
- TRAF1 and C5: Contribute to chronic inflammation
- PTPN22: Linked to onset and progression of RA
Some people with RA test positive for some or all of these genetic markers while other people are negative.
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Key Points About Juvenile Idiopathic Arthritis
- JIA is a form of arthritis in children ages 16 or younger. It causes joint inflammation and stiffness for more than 6 weeks.
- The disease may affect a few joints or many joints. It may cause symptoms all over the body.
- The most common symptoms include swollen, stiff, warm, red, and painful joints.
- Treatment options include medicines, physical therapy, healthy eating and exercise, eye exams, and rest.
Summary And Future Directions
There are multiple genetic and environmental factors that have been associated with RA. The strongest of these are familial associations and in particular FDR status, although it is not yet clear if these associations are due to genetic or environmental factors, or both, or even possible increased diagnosis within families due to awareness of disease . Other strong and consistent factors include the presence of alleles containing the SE, female sex, exposure to tobacco smoke and some dietary factors such as intake of omega-3 fatty acids.
Importantly, given the implementation of prevention trials for RA, all of these risks must now be understood in the context of understanding how to identify individuals at-risk for future RA through accurate prediction models, and understanding the pathophysiology of disease so that RA-related autoimmunity can be modified across its stages of development to improve active disease as well as to develop effective preventive interventions .
While addressing these issues is daunting, the fact that there are prevention trials underway should provide hope and encouragement that further study can lead to a major paradigm shift where prevention in RA becomes a reality.
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