title: The environment, geo-epidemiology, and autoimmune disease: Rheumatoid arthritis.
abstract: Rheumatoid arthritis (RA) is a chronic inflammatory joint disease characterized by a distinctive pattern of bone and joint destruction. RA patients have an increased risk of death. The incidence and prevalence of RA vary across populations, statistical methods, and disease definitions. In North America and Northern Europe, the incidence of RA is estimated at 20-50 cases per 100,000 population and the prevalence at 0.5-1.1%. Lower incidences and prevalences have been reported in Southern Europe, and few data are available for developing countries. Some studies showed declining incidences and prevalences after the 1960s. RA is a multifactorial disease that results from interactions between genetic and environmental factors. The main genetic factors are HLA-DRB1 and the tyrosine-phosphatase gene PTPN22. Among environmental factors implicated in the development of RA, smoking shows the strongest association with RA susceptibility and is also linked to worse outcomes. The aim of this review is to discuss the available data on the incidence and prevalence of RA, as well as the genetic and environmental risk factors associated with RA.
authors.affiliation: EA2216, IFR148, Université de Bretagne Occidentale, Brest, and Service de Rhumatologie, Centre Hospitalier Universitaire de Brest, Brest, France.
authors.forename: Gabriel J
authors.initials: GJ
authors.lastname: Tobón
authors.forename: Pierre
authors.initials: P
authors.lastname: Youinou
authors.forename: Alain
authors.initials: A
authors.lastname: Saraux
mesh_terms: D000818:Animals; D001172:Arthritis, Rheumatoid / Q000453:epidemiology* / Q000235:genetics / Q000276:immunology; D005060:Europe; D020022:Genetic Predisposition to Disease; D005843:Geography; D006684:HLA-DR Antigens / Q000235:genetics*; D059811:HLA-DRB1 Chains; D006801:Humans; D015994:Incidence; D009656:North America; D011110:Polymorphism, Genetic; D015995:Prevalence; D054596:Protein Tyrosine Phosphatase, Non-Receptor Type 22 / Q000235:genetics; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects
chemical_list: D006684:HLA-DR Antigens; D059811:HLA-DRB1 Chains; C516765:PTPN22 protein, human; D054596:Protein Tyrosine Phosphatase, Non-Receptor Type 22