• Cardiovascular risk management should be mandatory in rheumatoid arthritis and other types of inflammatory rheumatic disease. The Eular Task Force recommendations state that inflammation may be the key to heightened cardiovascular risks and suggest that rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PsA) patients should undergo compulsory cardiovascular risk management. The recommendations suggest that existing cardiovascular risk calculators should be adapted to the increased cardiovascular risk in inflammatory rheumatic disease patients.
For example, the risk of cardiovascular disease (CVD) for people with rheumatoid arthritis (RA) has been found to be comparable to the risk of CVD in people with type 2 diabetes, according to the conclusions of two studies reported by Dr. Mike Peters, of the VU Medical Center and Jan van Breemen Institute, in Amsterdam, The Netherlands. Dr. Peters said, "These two studies suggest that RA patients should be considered an important cardiovascular disease risk factor. Healthcare professionals treating those with the disease should therefore be aware of this elevated risk and advise their patients to follow a healthy diet and lifestyle and be alert to the early signs and symptoms of CVD in addition to managing their RA.
• Lupus manifestation in patients of European ancestry was the subject of a research study. Professor Lindsey A. Criswell, of the University of California, San Francisco, presented results of the study involving 1,270 patients who had at least 90 percent European ancestry.
The researchers found that Southern European ancestry contributes to more severe manifestations of systemic lupus erythematosus (SLE) such as nephritis (inflammation of the kidneys) and increased production of specific autoantibodies (antibodies that fail to recognize and therefore attack the body's own cells, tissues, or organs).
Northern European ancestry is shown to be positively associated with photosensitivity and discoid rash, which are relatively mild manifestations of SLE. It was inversely associated with anti-nuclear autoantibodies, anticardiolipin antibodies, arthritis, and renal disorder.
Prof. Criswell reported, "This study shows a clear correlation between specific European ancestry and SLE disease severity and autoantibody production, which may further assist in understanding the risk factors for the condition and should help us better understand and manage this disease in the future."
• What are the implications of early life infections for potential autoimmune disease patients? "Whilst recent research has suggested that early life infections are of importance to the maturation of the immune system in general, our analysis shows a link between perinatal infection and increased rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA) in particular, highlighting the importance of a child's formative months on his or her rheumatic health in later life." This was the observation of investigator Dr. Cecilia Carlens of The Karolinski University Hospital, in Stockholm, Sweden.
The study conducted by Dr. Carlens and colleagues reviewed recorded data on 333 RA patients and 3,334 JIA patients. Some parts of the study suggested that perinatal characteristics, such as low birth weight and the duration of the gestational period, may also affect arthritis later in life. A longer gestational period of over 42 weeks emerged as a potential risk factor for developing JIA.
• The specific location of the TRAF1/C5 gene is associated with multiple autoimmune diseases. Results reported recently from two separate studies, in The Netherlands and the United States, have shown that the specific location of the TRAF1 (Tumor Necrosis Factor-Receptor Associated Factor 1) and C5 (complement component 5) may have an important role in multiple autoimmune diseases.
Both TRAF1 and C5, immune-related genes which sit adjacent to one another on chromosome 9, are thought to be closely involved in the onset and/or perpetuation of the inflammatory process. The TRAF1/C5 gene has previously been established as a genetic risk factor for rheumatoid arthritis. In a study conducted at Leiden University Medical Center, in The Netherlands, a further link was also found between the gene location and the presence of autoantibodies (antibodies against antigens naturally occurring in the human body commonly found in patients with immune disorders). Since many autoimmune disorders tend to coexist within a given family as well as an individual, this indicates that there may be a common genetic pathway.
Lead researcher Ms. Fina Kurreeman commented, "We hope that further study will give an insight into potential shared genetic pathways across autoimmune disorders and may even stimulate innovation into novel therapeutic targets in the future."
--Source: Annual European Congress of Rheumatology of the European League Against Rheumatism press release, June 13, 2008
