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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

  • 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
  • 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

functional impairment
Functional Impairment

functional impairment6
Functional Impairment

Morning stiffness

>1 hour

functional impairment7
Functional Impairment

Arthritis of >3

of the following joints:

PIP, MCP, wrist,

elbow, knee, ankle,

and MTP joints

functional impairment8
Functional Impairment


involvement of joints

functional impairment9
Functional Impairment

Rheumatoid nodules

functional impairment10
Functional Impairment

Positive serum

rheumatoid factor

functional impairment11
Functional Impairment

Radiographic changes

including erosions

or bony decalcification

risk factors13

HLA - DR complex

DR-1 & DR-4


HLA - I kappa BL



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
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