Who gets rheumatoid arthritis (RA)? Can you get RA?
RA is a systemic autoimmune disease. In autoimmune diseases, the immune system malfunctions and starts attacking the body’s own cells. In RA, this affects the joints and other systems in the body, such as internal organs, tendons, and the vascular system.
Although new medications called the Biologics have enabled many more people to live almost normal lives, a significant amount of individuals still do not respond to available medication. RA is expensive, both for the individual and society, accounting for $9 billion in healthcare costs.
We still don’t know what causes RA, although researchers are beginning to identify factors that may contribute to the immune system process that triggers the development of RA in people who are genetically predisposed.
We do have information about the people who have RA. It is estimated that approximately 1 percent of the population develops the disease. The estimate of the prevalence in the population given by many sources is that 1.5 million people in the US have RA.
Gender and age
Gender is a factor in who gets RA. Women develop the disease three times more often than men. This seems to indicate that hormones may play a role in the development of the disease. There are several additional factors that point in this direction.
Women tend to get RA in childbearing years, between the ages of 30 and 60. Men tend to get RA later in life. As well, in pregnant women with RA, up to 80 percent experience remission while pregnant, although the disease tends to come back about six weeks after the birth of the baby. On that note, the large number of anecdotal reports that women with RA may experience a flare of symptoms during PMS could support the theory that hormones may be implicated.
There is also evidence that there is at least in part a genetic basis for RA. Research has shown that people who have a particular genetic marker called the HLA shared epitape have a greater risk of developing RA. Additionally, a number of other genes are also connected to RA, especially genes responsible for controlling immune responses and inflammation.
If one of your family members has the disease, you have an increased risk of developing it, too. Many people are concerned about possibly passing RA on to their children. If you come from a family where your mother and grandmother both had RA, it may be more likely. However, the average risk of a first-degree relative (child or sibling) having RA is less than 5 percent.
Enviromental risk factors
One of the most exciting developments in recent years is more insight into the pathogenesis of RA—that is what causes RA to develop. Research seemed to indicate that it is a mix of genetics and environmental risk factors. Three specific factors have been identified: smoking, periodontal disease, and micro bacteria in the gut. The latter is especially intriguing, with some evidence of a link between a particular micro-bacteria called Clostridium and arthritis, but the dynamics of how this process occurs is still not known.
Environmental risk factors are also thought to be the potential culprits behind a recent rise in RA in women. A study looked at over 50 years of epidemiological data and found the rate of RA in women rising 2.5 percent per year in the period from 1995 to 2007. The authors of the study speculated that the environmental factors contributing to this rise include smoking, vitamin D deficiency, and lower dose synthetic estrogen in birth control.
Given all this information, is it possible to predict who will develop RA?
Unfortunately, the answer is a resounding not really With one exception. A newer blood test called the anti-CCP (or anti-cyclic citrullinated peptide) measures an antibody that has been connected to RA. This test is much more accurate than previous blood tests.
The anti-CCP test can also be positive up to 15 years before a person develops RA. This has given researchers an intriguing challenge to find a way to deal with it before the disease becomes active. Some believe that it will soon be possible to find a way to turn off RA before it starts in those individuals.
My thoughts****: having lived with this disease for over 40 years, I can honestly say that now is the most exciting period in RA research. So many new discoveries are made every year and there is so much hope for the future. I never used to think that I would see medications like the Biologics, and yet, here they are. Now I truly believe that we will see a cure in my lifetime.
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Lene writes the award-winning blog The Seated View. She’s the author ofYour Life with Rheumatoid Arthritis: Tools for Managing Treatment, Side Effects and Pain and 7 Facets: A Meditation on Pain.
Lene Andersen is the Community Leader for HealthCentral’s RA Community. Lene (pronounced Lena) is an award-winning writer, health and disability advocate, and photographer living in Toronto. She’s written several books, including Your Life with Rheumatoid Arthritis: Tools for Managing Treatment, Side Effects and Pain, and 7 Facets: A Meditation on Pain, as well as the award-winning blog, The Seated View. Follow Lene on Twitter @TheSeatedView and on Facebook. Watch her story on HealthCentral.