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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

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

Jessica Larson

Advisor: Sam Powdrill, PA-C

objectives
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
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
Pathophysiology Review

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

functional impairment
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
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
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
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
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
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
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
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
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
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
References
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references cont
References (cont)
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