REPORT

Clinical aspects

Should infection still be considered as the most likely triggering factor for rheumatoid arthritis?^*

S M Carty¹, N Snowden², A J Silman³

¹ Rheumatology Department, University Hospital of Wales, Cardiff, Wales, UK
² Department of Rheumatology, North Manchester General Hospital, Manchester, UK
³ ARC Epidemiology Unit, University of Manchester, Manchester, UK

Correspondence to:
Correspondence to:
Professor A J Silman
ARC Epidemiology Unit, University of Manchester, Manchester, M13 9PT, UK; alan.silman@man.ac.uk

Keywords: rheumatoid arthritis; infection; triggering factor

The first 150 words of the full text of this article appear below.

Although genetic factors are important in the development of rheumatoid arthritis (RA), not all those who are genetically susceptible develop the disease. Twin studies in the United Kingdom and Australia have shown disease concordance rates in monozygotic twins of between 15 to 21%.^1,2 Earlier studies also showed only modest concordance for autoantibody and immunoglobulin production within twin pairs.^3,4 There is weak evidence, however, of an increased concordance of RA, rheumatoid factor, and other autoantibodies within spouse pairs.⁵ These observations have encouraged the search for environmental triggers, such as infection. In this issue of The Journal [The Journal of Rheumatology], for example, a report from Finland has highlighted the high prevalence of prior infection in patients newly presenting with all forms of inflammatory arthritis.⁶

Evidence that infection is the likeliest environmental trigger for RA is considered in this review: First, we look at the different ways in . . . [Full text of this article]

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