Rheumatoid arthritis: heredity, estrogen and progression

You've been diagnoses with rheumatoid arthritis. Now what? Learn how it will effect your hormones and overall well-being.

• It seems that many people who develop rheumatoid arthritis inherited their susceptibility to the disease.
• Several different genes probably determine whether someone will have a tendency to develop RA and how severe his or her disease will be. As you might expect, these tend to be genes that control the immune system.
• For example, 65 per cent of people with RA have a genetic marker — a protein called HLA-DR4 — on the surface of their white blood cells.
• White cells play major roles in the body's effort to fight infections, so this protein may somehow trick white cells into attacking the body's own tissues.

• Women are much more susceptible to autoimmune diseases than men — and RA is no exception: Three of every four people who develop RA are women, and researchers suspect that estrogen is the culprit.
• Combined with certain "susceptibility genes," estrogen seems to tip the balance toward developing RA: For example, a woman who inherits the genes will very likely develop the disease, while a brother with the same genes will remain healthy.
• When a woman has a genetic tendency to develop RA, estrogen may super-sensitize her immune system so that — in response to some infection — immune cells launch an attack on her tissues and the invading microbes.

• In about 80 per cent of cases, RA begins slowly, affecting just a few joints at first, typically those in the fingers, wrists or toes.
• Eventually, the disease almost always ends up affecting 20 joints or more, including the shoulders, ankles, hips, knees and other joints.
• But not all cases develop gradually: RA sometimes appears seemingly overnight, involving many of the body's joints in just a matter of days.If inflammation persists, the synovial membrane's cells may start to grow uncontrollably, forming extra tissue called pannus and thickening the normally thin membrane.
• The joint becomes swollen and feels puffy to the touch.