Rheumatoid Arthritis Case Study

Rheumatoid Arthritis (RA) is an autoimmune disease affecting the synovia of joints, specifically smaller joints such as fingers, hands, wrists and knees (Roundtree, 2014). Evidence discovered as early as the 1970’s suggests hereditary genetic links in the development of RA. According to Hasthorpe (2011), “the disease may be a result of a predetermined inherited gene or susceptibility genes triggered by environmental risk factors” (p. 35). The costs of RA are numerous. There are direct medical costs due to the use of healthcare resources. Indirect costs, mostly attributable to loss of productivity as an employee, are due to pain; fatigue; and disability. Further indirect costs include depression, anxiety, and decreased quality of life (Chrvala, 2013). Irreversible joint destruction can occur within …show more content…
In Caucasians, the HLA genes involved are HLA-DRB1* 0401 (present in 50-61% - relative risk of 5 to 11), HLA-DRB1* 0404 (present in 27-37% - relative risk 5 to 14) and HLA-DRB1* 0101 (present in 13-27% - relative risk 1-2) (Barton, 2015). Second, there are HLA alleles which may increase the risk for developing more severe, erosive disease. Having one DR4+ allele increases this risk, while having two copies confers an even higher risk of developing this more severe form of RA. The more severe form includes extraarticluar disease manifestations such as vasculitis, rheumatoid lung disease, and Felty’s syndrome. Furthermore, joint damage is more rapid and progressive in patients with two alleles (Barton, 2015). Third, there are HLA DRB1 alleles which promote the citrullination of arginine residues. This process results in the formation of anti-CCP antibodies. According to Barton (2010), “The ACPA’s may be a path variable to explain the association of the shared epitope with RA susceptibility and/or severity” (p. 7). Citrullinated proteins bind to T cells more strongly and create a more heightened response (Barton,