Rheumatoid Arthritis Treatment 1

Question 1

what is the strongest environmental risk factor for RA

Answer 1

cigarette smoking
- childhood and current low socioeconomic status are also associated with increasing risk

Question 2

what factors contribute to the female predominance in RA

Answer 2

hormonal and reproductive factors

Question 3

what criteria scheme is used for the diagnosis of RA

Answer 3

ACR/EULAR criteria

Question 4

describe how nutrition affects RA

Answer 4

1. conflicting results with some showing:
   - protective link between olive oil/fish
   - increased risk between red meat and protein
   - but neither proven in large cohort studies
2. low vitamin D and C and possibly copper and selenium may have a role

Question 5

describe how medication influence affects RA

Answer 5

1. Statins have modest antiinflammatory activity
2. studies show RA risk possibly decreases by up to 40% in those taking statins
3. ongoing research in progress to assess antiinflammatory effects

Question 6

describe how infectious agents affect RA

Answer 6

1. these are potential associations, although epidemiological confirmation has not been possible
   - Epstein barr virus
   - human parvovirus

Question 7

describe how socioeconomic status affects RA

Answer 7

1. Data is varied
2. most recent data suggests lower education level and occupational class favours RA

Question 8

describe how reproductive and endocrine factors affect RA

Answer 8

1. Pregnancy affects the onset of RA
2. one study showed that risk of RA during pregnancy is reduced, but increased in the 12 months after delivery
3. some hormonal factors are in play

Question 9

describe how birth weight affects RA

Answer 9

1. higher birth weight has been linked to RA
2. babies >4.5kg have double the risk of developing RA
   - probably a hypothalamic pituitary axis dysfunction

Question 10

what are the preclinical features of RA

Answer 10

1. autoantibodies precede disease
2. can be 5-10 years before symptoms
3. levels rise as symptoms emerge
4. rheumatoid factor
5. anti cyclic citrullinated peptide antibodies (anti-CCP)

Question 11

What are the 4 phases in the natural history of RA

Answer 11

1. phase 1- genetic risk
2. phase 2- preclinical autoimmunity
3. phase 3- initial signs/symptoms
4. phase 4- classifiable clinical disease

Question 12

what antibody changes occur in RA

Answer 12

increase in levels of anti CCP antibodies

Question 13

what is the aim of predicting onset and possible prevention of RA

Answer 13

aim is to ID the high risk antibodies and address the preclinical case before it transitions

Question 14

in the preclinical phase of RA, what 3 markers of the disease become apparent and why is this important as a prognostic indicator

Answer 14

1. anti-CCP antibodies, rheumatoid factor and acute phase reactants
2. more likely to have poor prognostic outcome, so allows more aggressive treatments to try and improve prognostic outcome