Rheumatoid Arthritis Sample Clauses

Rheumatoid Arthritis. Ovidrelt Infertility
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Rheumatoid Arthritis. Rheumatoid arthritis (RA) is a the most common form of inflammatory arthritis. The exact global prevalence is difficult to ascertain as there appears to be regional variation. A recent meta-analysis suggested RA affected just over 0.5% of the population but the rates were higher in urban areas than in rural settings1. Whilst the severity of RA varies between patients, it has historically been a major cause of disability. Untreated RA can lead to permanent, irreversible joint damage and increased cardiovascular morbidity. Aetiology of RA: Genetics The onset of RA is thought to be due to a combination of environmental and genetic factors. Some of our earlier understanding into the genetics of RA comes from twin studies. Research from the Finnish Twin cohort that was published in the 1980s showed that the concordance percentage for RA was 12.3 in monozygotic twins and 3.5 in dizygotic twins2. Similar rates have been reported in Japan and the United Kingdom more recently3, 4. New techniques such as whole-genome scans have led to the discovery of various genetic variants that predispose individuals to RA5. To date, the most important genetic risk factor identified for the development of RA are the HLA–DRB1 alleles encoding for the shared epitope (SE). These are strongly associated with the development of anti–cyclic citrullinated peptide (anti-CCP) antibodies. Anti-CCP antibodies are highly specific for RA and are in general associated with a more severe form of disease with a greater chance of developing erosions. The heritability of anti-CCP negative rheumatoid arthritis is similar to that of anti- CCP positive RA suggesting that other genetic factors play a significant role in the development of anti-CCP negative disease5. One such genetic association is the single nucleotide polymorphism in STAT4 that is an important risk factor for CCP negative RA. This has been demonstrated in multiple European cohorts6. Whilst over 100 other loci have been identified that are associated with the development of RA, the effect size of these are small. Excluding the shared epitope, these loci are thought to explain only 5% of the genetic association with RA7. Aetiology of RA: Environmental Factors A number of different environmental factors have been identified as potentially playing a role in the development of RA. These include infective pathogens, cigarette smoking, air pollution and silica. Whilst in the majority of cases, no clear infective trigger is identified, resea...

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