Rheumatoid arthritis and infection: a population approach

Article Abstract:

Rheumatoid arthritis (RA) is a joint disease characterized by joint inflammation, stiffness, swelling, overgrowth of cartilage tissue, and pain. It is thought to be an immune reaction to injury from environmental factors, such as infection by a microorganism. The role of infection and the microorganisms that may be involved are reviewed. Unlike most infectious diseases, which occur at a specific time and place, RA is ubiquitous. The potential source of infection in RA may be determined by evaluating whether RA patients were born during an epidemic of infection, such as influenza. RA tends to occur within families, but the roles of genetic and environmental factors are not clear. The Epstein-Barr virus, human parvovirus, retrovirus, mycoplasma, and protozoa have been implicated as infectious agents in RA, although a definite identification of the cause has been difficult due to several problems. RA differs from most infections epidemiologically and clinically. The abnormal immune response in RA persists even when the infection has resolved. In evaluating susceptibility to RA, the characteristics of the patient may be more important than the infective agent. Although it remains likely that an infective agent triggers the abnormal immune response in RA, studies have been unable to determine the infectious cause. Future research is needed to identify persons susceptible to RA. (Consumer Summary produced by Reliance Medical Information, Inc.)

Infection, Causes of, Physiological aspects, Demographic aspects, Joint diseases

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Is poor pregnancy outcome a risk factor in rheumatoid arthritis?

Article Abstract:

Three times as many women as men have rheumatoid arthritis (RA), indicating the likely involvement of hormonal and gynecological factors in the etiology of this disease. RA typically goes into remission during pregnancy and relapses after delivery. RA also changes according to the stage of the menstrual cycle. It is not known whether women with poor reproductive performance, as measured by an increased rate of stillbirths or spontaneous abortions, are at increased risk for developing RA in the future. In this study, no significant increases in the rates of spontaneous or induced abortions or postnatal deaths were seen in 195 women with RA. In fact, women who had RA had lower rates of spontaneous abortion than other women. This suggests that spontaneous abortions may even protect women from getting RA. There was a slight increase in the rate of stillbirths among women with RA, but it was not statistically significant. Therefore, this study showed that poor outcomes of pregnancy do not appear to be a risk factor for the development of RA. The racial distribution of subjects in this study was 95 percent white, and this differed from some other studies; the possible relevance of racial background to these issues should be investigated further. (Consumer Summary produced by Reliance Medical Information, Inc.)

Women, Risk factors, Statistics, Women's health, Abortion, Pregnancy, Complications of, Pregnancy complications, Miscarriage, Still-birth, Stillbirth, Fetal death

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Should patients with recent onset rheumatoid arthritis be offered genetic screening?

Article Abstract:

It does not appear appropriate to offer routine genetic screening for rheumatoid arthritis (RA) until more is known of the results' implications and the tests are more reliable. Researchers have found a strong association between RA and a section of chromosome six called the HLA complex that codes for immune responses and contains a sequence called the shared epitope. However, studies are inconclusive as to whether patients who test positive for this genetic complex will develop a worse form of this disease or would benefit from early treatment.

Planning, Genetic aspects, Genetic screening, Genetic testing, HLA class II antigens

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