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
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