Advances in identifying genetic and non genetic risk factors of rheumatoid arthritis
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Advances in identifying genetic and non-genetic risk factors of rheumatoid arthritis. Jessica Larson Advisor: Sam Powdrill, PA-C. Objectives. Review of epidemiology & pathophysiology of RA Understand functional impairment

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Advances in identifying genetic and non genetic risk factors of rheumatoid arthritis l.jpg

Advances in identifying genetic and non-genetic risk factors of rheumatoid arthritis

Jessica Larson

Advisor: Sam Powdrill, PA-C


Objectives l.jpg
Objectives

  • Review of epidemiology & pathophysiology of RA

  • Understand functional impairment

  • Learn risk factors that determine the onset & severity in development of RA

  • Pre-RA red flags

  • How to advise patient in clinic to reduce or prolong outcome of RA


Epidemiology l.jpg
Epidemiology

  • Most common inflammatory polyarthritis

  • One percent or 2.1 million adults in US

  • Women 2-3x more affected than men

  • Age of onset is 40-60 years old

  • Smokers 4x more likely to develop

  • First-degree relative prevalence rate is 2-3x more like to develop

  • Mortality is higher, in severe RA mortality approaches that of CHF or Hodgkin disease


Pathophysiology review l.jpg
Pathophysiology Review

http://www.hopkins-arthritis.org/rheumatoid/rheum_clin_path.html#preven


Functional impairment l.jpg
Functional Impairment

www.faqs.org/health/images/uchr_06_img0591.jpg

www.csmc.edu/images/354031_Adv_Rheumatoid_Arthritis-2sm.jpg.jpg

http://podiatry.curtin.edu.au/encyclopedia/rheumatoid_arthritis/figure1.jpg


Functional impairment6 l.jpg
Functional Impairment

www.faqs.org/health/images/uchr_06_img0591.jpg

www.csmc.edu/images/354031_Adv_Rheumatoid_Arthritis-2sm.jpg.jpg

Morning stiffness

>1 hour

http://podiatry.curtin.edu.au/encyclopedia/rheumatoid_arthritis/figure1.jpg


Functional impairment7 l.jpg
Functional Impairment

www.faqs.org/health/images/uchr_06_img0591.jpg

www.csmc.edu/images/354031_Adv_Rheumatoid_Arthritis-2sm.jpg.jpg

Arthritis of >3

of the following joints:

PIP, MCP, wrist,

elbow, knee, ankle,

and MTP joints

http://podiatry.curtin.edu.au/encyclopedia/rheumatoid_arthritis/figure1.jpg


Functional impairment8 l.jpg
Functional Impairment

www.faqs.org/health/images/uchr_06_img0591.jpg

www.csmc.edu/images/354031_Adv_Rheumatoid_Arthritis-2sm.jpg.jpg

Symmetric

involvement of joints

http://podiatry.curtin.edu.au/encyclopedia/rheumatoid_arthritis/figure1.jpg


Functional impairment9 l.jpg
Functional Impairment

www.faqs.org/health/images/uchr_06_img0591.jpg

www.csmc.edu/images/354031_Adv_Rheumatoid_Arthritis-2sm.jpg.jpg

Rheumatoid nodules

http://podiatry.curtin.edu.au/encyclopedia/rheumatoid_arthritis/figure1.jpg


Functional impairment10 l.jpg
Functional Impairment

www.faqs.org/health/images/uchr_06_img0591.jpg

www.csmc.edu/images/354031_Adv_Rheumatoid_Arthritis-2sm.jpg.jpg

Positive serum

rheumatoid factor

http://podiatry.curtin.edu.au/encyclopedia/rheumatoid_arthritis/figure1.jpg


Functional impairment11 l.jpg
Functional Impairment

www.faqs.org/health/images/uchr_06_img0591.jpg

www.csmc.edu/images/354031_Adv_Rheumatoid_Arthritis-2sm.jpg.jpg

Radiographic changes

including erosions

or bony decalcification

http://podiatry.curtin.edu.au/encyclopedia/rheumatoid_arthritis/figure1.jpg



Risk factors13 l.jpg

GENETIC

HLA - DR complex

DR-1 & DR-4

NIMA & NIPA

HLA - I kappa BL

NON-GENETIC

Smoking

Neuroendocrine imbalances:

Low sex hormones

Low cortisol levels

Vascular endothelial alterations in men

Immunologic markers

Risk Factors


Pre ra red flags l.jpg
Pre-RA red flags

CCP antibody immunological markers appear many years (as many as 12) before onset of RA with increased risks if:

  • Smoking (>20 pack-years)

  • Coffee consumption (>10 cups/day)

  • Ever use of oral contraceptives

  • First-degree relative of schizophrenia

  • Obesity (3x risk)

  • Age of menarche >15 years old (2x risk)


What can pas do l.jpg
What can PAs do?

  • If there is a family history of RA, it is especially important to NOT SMOKE

  • Anti-CCP test is a blood test that can be ordered by the PA

    • RF is ~81-87% specific post-onset

    • CCP is ~96% specific and available earlier

  • Tell them to stay active and loose weight


References l.jpg
References

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References cont l.jpg
References (cont)

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  • en.wikipedia.org/wiki/Human_leukocyte_antigen


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