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Monday, 25 November 2013

Rheumatoid Arthritis (RA) - The Risk Factors

Rheumatoid Arthritis
Rheumatoid Arthritis is defined a chronic disorder as a result of inflammation, affecting mostly the flexible (synovial) joints and tissues and organs in the body. The disease affects more women than in men and generally occurs after the ages of 40 and diminishes the quality of life of many elders.
Risk factors
1. Age
The risk of Rheumatoid Arthritis increases with age. Ina retrospective study of RA in the elderly aged 65 and over, we’ve compiled ten cases hospitalized over a period of 4 1/2 years in the service of Internal Medicine, Habib Thameur Hospital (Tunis), there were 8 women and 2 men. The average age was 70.6 years. The onset of arthritis and the disease was progressive in seven cases. An inflammatory syndrome was present in seven cases. Rheumatoid factor was positive in eight cases. Five patients were classified as stage III and IV according to the radiological classification of Steinbrocker. The treatment was based on painkillers and anti-inflammatory drugs in all cases. Long-term treatment was initiated in seven patients. The outcome was favorable in all cases(16).
2. Gender and body mass index
If  you are women and overweight, you are at increased risk to develop Rheumatoid Arthritis. In the study to investigate whether body mass index (BMI), as a proxy for body fat, influences rheumatoid arthritis (RA) disease activity in a gender-specific manner, showed that compared to the normal BMI range, being obese was associated with a larger difference in mean DAS28 (0.23, 95% CI: 0.11, 0.34) than being overweight (0.12, 95% CI: 0.03, 0.21); being underweight was not associated with disease activity. These associations were more pronounced among women, and were not explained by any single component of the DAS28(17). Others in the study of Socioeconomic and employment status of patients with rheumatoid arthritis in Korea, suggested that Middle- and old-aged women accounted for the majority of the Korean RA population, which had a significant lower employment rate compared to the population without RA for both sexes. RA resulted in considerable productivity loss in Korea(18a).
3. Race
Genome-wide association studies and meta-analysis indicate that several genes/loci are consistently associated with rheumatoid arthritis (RA) in European and Asian populations(18).
4. Smoking
In the study to assess the effects of smoking on disease outcome in a large cohort of patients with early rheumatoid arthritis (RA), showed that the present study gives some support to earlier data indicating that RA patients who smoke have a more active disease but further studies are needed to confirm this(19).
5. Family history
In the study to investigate the risk of rheumatoid arthritis (RA) in the first degree relatives and to investigate whether the sex of the parent influences the pattern of inheritance, showed that  the familial clustering of RA and suggests that mothers confer susceptibility to RA on their offspring more often than fathers(20).
6. Vaccines
Certain vaccines may causes Rheumatoid Arthritis. In the etrospective chart review of approximately 1 million Kaiser Permanente Northern California members ages 15-59 years from 1997 through 1999. In a cohort analysis, rates of new-onset RA were compared between vaccinated and unvaccinated within 90, 180, and 365 days, showed that 378 RA cases were included in the cohort analysis; 37 additional cases were included in the case-control analysis. In the cohort analysis the relative risks of RA onset within 90, 180, or 365 days of hepatitis B vaccination were not significant (R.R.=1.44, p=0.53; R.R.=1.67, p=0.22; R.R.=1.23, p=0.59 respectively). We found a possible association between RA and influenza vaccine in the previous 180 and 365 days in the cohort analysis (R.R=1.36, p=0.03; R.R.=1.34, p=0.01 respectively), but in the case-control analysis, cases were no more likely than controls to have received any of the three vaccines(21).
7. Other risk factors
Changes in the female hormonal environment such as in pregnancy, breastfeeding and the use of the oral contraceptive (OC) pill appear to have a role. Of the traditional lifestyle exposures, cigarette smoking has been associated with a consistently increased risk that might also apply to the passive inhalation of smoke. Occupation probably has a minor influence, although exposure to silica dust is of aetiological importance. Recent studies have highlighted a role for diet, with suggestions that diets high in caffeine, low in antioxidants and high in red meat may contribute to an increased risk. The most plausible environmental exposure is infection and although several decades of study have produced few definitive candidate organisms, Epstein-Barr virus (EBV) remains an interesting target(22).
8. Etc.

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Sources
(16) http://www.ncbi.nlm.nih.gov/pubmed/22693083
(17) http://www.ncbi.nlm.nih.gov/pubmed/20810033
(18) http://www.ncbi.nlm.nih.gov/pubmed/22355377
(18a) http://www.ncbi.nlm.nih.gov/pubmed/22611518
(19) http://www.ncbi.nlm.nih.gov/pubmed/21338325
(20) http://www.ncbi.nlm.nih.gov/pubmed/9263145
(21) http://www.ncbi.nlm.nih.gov/pubmed/21763385
(22) http://www.ncbi.nlm.nih.gov/pubmed/16766362