Genetic Determination of Susceptibility and Severity in Rheumatoid Arthritis
Authors: Robert Winchester
Journal: Annals of Internal Medicine (1992)

Editorials15 November 1992Genetic Determination of Susceptibility and Severity in Rheumatoid ArthritisRobert Winchester, MDRobert Winchester, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-117-10-869 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptRheumatoid arthritis is increasingly recognized to be a potentially severe illness that shortens life expectancy by an average of 10 to 15 years. Indeed, patients with severe articular and extra-articular disease have 5-year survival rates of less than 50%, similar to survival in patients with stage IV Hodgkin disease (1, 2). Moreover, the long-term outlook for roughly half of all patients receiving the best current treatment for rheumatoid arthritis is not an optimistic one (3). Although current practice involves treating more seriously involved patients with considerably more aggressive antiinflammatory and immunosuppressive drugs than are used in those with milder disease,...References1. Pincus T. New concepts in prognosis in rheumatic diseases for the 1990s. In: Prognosis in the Rheumatic Diseases. Bellamy N, ed. Dordrecht: Kluwer Academic Publishers; 1991:451-92. Google Scholar2. GordonSteinBroder DJL. The extra-articular features of rheumatoid arthritis. A systematic analysis of 127 cases. Am J Med. 1973;54:445-52. CrossrefMedlineGoogle Scholar3. ScottSymmonsCoultonPopert DDBA. Long-term outcome of treating rheumatoid arthritis: results after 20 years. Lancet. 1987; 1:1108-11. CrossrefMedlineGoogle Scholar4. Harris E Rheumatoid arthritis. Pathophysiology and implications for therapy. N Engl J Med. 1990;322:1277-89. CrossrefMedlineGoogle Scholar5. WeyandHicokConnGoronzy CKDJ. The influence of HLA-DRBl genes on disease severity in rheumatoid arthritis. Ann Intern Med. 1992;117:801-6. LinkGoogle Scholar6. AstorgaWilliams GR Altered reactivity in mixed lymphocyte culture of lymphocytes from patients with rheumatoid arthritis. Arthritis Rheum. 1969;12:547-54. CrossrefMedlineGoogle Scholar7. Stastny P. Mixed lymphocyte cultures in rheumatoid arthritis. J Clin Invest. 1976;57:1148-57. CrossrefMedlineGoogle Scholar8. WinchesterWernetKunkelDupontJersildFu RPHBCS. Recognition by pregnancy serums of non-HL-A alloantigens selectively expressed on B lymphocytes. J Exp Med. 1975;141:924-9. CrossrefMedlineGoogle Scholar9. Winchester R. B-lymphocyte allo-antigens, cellular expression, and disease significance with special reference to rheumatoid arthritis. Arthritis Rheum. 1977;20:159-63. Google Scholar10. WinchesterDwyerRose RES. The genetic basis of rheumatoid arthritis: the shared epitope hypothesis. In: Nepom G, ed. Genetic Factors. 18th edition. New York: Barton Dudlick; 1992:761-83. Google Scholar11. YoungJaraquemadaAnadFestensteinCorbettHay ADLHNF. Association of HLA-DR4/Dw4 and DR2/Dw2 with radiological changes in a prospective study of patients with rheumatoid arthritis. Arthritis Rheum. 1984;27:20-5. CrossrefMedlineGoogle Scholar12. OllierThomson BW. Population genetics of rheumatoid arthritis. In: Nepom G, ed. Genetic Factors. 18th edition. New York: Rheumatic Disease Clinics of North America; 1992:741-59. CrossrefGoogle Scholar13. SingalGreenReidGladmanBuchanan DBBDW. HLA-D region genes and rheumatoid arthritis (RA): importance of DR and DQ genes in conferring susceptibility to RA. Ann Rheum Dis. 1992;51:23-8. CrossrefMedlineGoogle Scholar14. StastnyOlsenPincusKhanBall PNTNB. DR4 and DR1 define different subsets of patients with rheumatoid arthritis. In: Immunology of HLA II. Dupont B, ed. New York: Springer-Verlag. 1989: 418-19. CrossrefGoogle Scholar15. GregersenSilverWinchester PJR. The shared epitope hypothesis. An approach to understanding the molecular genetics of rheumatoid arthritis susceptibility. Arthritis Rheum. 1987;30:1205-13. CrossrefMedlineGoogle Scholar16. JaraquemadaOllierAwadYoungSilmanRoitt AWJAAI. HLA and rheumatoid arthritis: a combined analysis of 440 British patients. Ann Rheum Dis. 1986;45:627-36. CrossrefMedlineGoogle Scholar17. de Jonghvan RomundeValkenbergde Langevan Rood BLHGJ. Epidemiological study of HLA and GM in rheumatoid arthritis and related symptoms in an open Dutch population. Ann Rheum Dis. 1984;43:613-19. CrossrefMedlineGoogle Scholar18. WillkensNepomMarksNettlesNepom RGCJB. Association of HLA-Dwl6 with rheumatoid arthritis in Yakima Indians. Further evidence for the "shared epitope" hypothesis. Arthritis Rheum. 1991;34:43-7. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: College of Physicians and Surgeons of Columbia University New York, NY 10032 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByMolecular Basis for Recognition of an Arthritic Peptide and a Foreign Epitope on Distinct MHC Molecules by a Single TCRAn HLA-DRB1∗0402 derived peptide (HV3 65-79) prevents collagen-induced arthritis in HLA-DQ8 transgenic miceAssessing Prognosis in Rheumatoid Arthritis Using Monoclonal Antibodies and Flow CytometryPresentation of self peptides by dendritic cells. Possible implications for the pathogenesis of rheumatoid arthritisPsoriasis Is a Visible Manifestation of the Skin's Defense against Micro-organisms 15 November 1992Volume 117, Issue 10Page: 869-871KeywordsAutoimmune diseasesDrugsGenetic determinismGenetic predispositionHodgkin lymphomaImmunosuppressivesLife expectancyRheumatoid arthritisSurgeons Issue Published: 15 November 1992 PDF DownloadLoading ...