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Ortíz-Fernández L, Martín J, Alarcón-Riquelme ME. A Summary on the Genetics of Systemic Lupus Erythematosus, Rheumatoid Arthritis, Systemic Sclerosis, and Sjögren's Syndrome. Clin Rev Allergy Immunol 2022; 64:392-411. [PMID: 35749015 DOI: 10.1007/s12016-022-08951-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2022] [Indexed: 11/03/2022]
Abstract
Systemic lupus erythematosus, systemic sclerosis, rheumatoid arthritis, and Sjögren's syndrome are four major autoimmune rheumatic diseases characterized by the presence of autoantibodies, caused by a dysregulation of the immune system that leads to a wide variety of clinical manifestations. These conditions present complex etiologies strongly influenced by multiple environmental and genetic factors. The human leukocyte antigen (HLA) region was the first locus identified to be associated and still represents the strongest susceptibility factor for each of these conditions, particularly the HLA class II genes, including DQA1, DQB1, and DRB1, but class I genes have also been associated. Over the last two decades, the genetic component of these disorders has been extensively investigated and hundreds of non-HLA risk genetic variants have been uncovered. Furthermore, it is widely accepted that autoimmune rheumatic diseases share molecular disease pathways, such as the interferon (IFN) type I pathways, which are reflected in a common genetic background. Some examples of well-known pleiotropic loci for autoimmune rheumatic diseases are the HLA region, DNASEL13, TNIP1, and IRF5, among others. The identification of the causal molecular mechanisms behind the genetic associations is still a challenge. However, recent advances have been achieved through mouse models and functional studies of the loci. Here, we provide an updated overview of the genetic architecture underlying these four autoimmune rheumatic diseases, with a special focus on the HLA region.
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Affiliation(s)
- Lourdes Ortíz-Fernández
- Institute of Parasitology and Biomedicine López-Neyra, CSIC, Parque Tecnológico de La Salud, 18016, Granada, Spain
| | - Javier Martín
- Institute of Parasitology and Biomedicine López-Neyra, CSIC, Parque Tecnológico de La Salud, 18016, Granada, Spain
| | - Marta E Alarcón-Riquelme
- GENYO. Center for Genomics and Oncological Research, Pfizer/University of Granada/Andalusian Regional Government, Av de la Ilustración 114, Parque Tecnológico de La Salud, 18016, Granada, Spain. .,Institute for Environmental Medicine, Karolinska Institutet, 171 77, Solna, Sweden.
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Latin American Genes: The Great Forgotten in Rheumatoid Arthritis. J Pers Med 2020; 10:jpm10040196. [PMID: 33114702 PMCID: PMC7711650 DOI: 10.3390/jpm10040196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/19/2020] [Accepted: 10/24/2020] [Indexed: 11/28/2022] Open
Abstract
The successful implementation of personalized medicine will rely on the integration of information obtained at the level of populations with the specific biological, genetic, and clinical characteristics of an individual. However, because genome-wide association studies tend to focus on populations of European descent, there is a wide gap to bridge between Caucasian and non-Caucasian populations before personalized medicine can be fully implemented, and rheumatoid arthritis (RA) is not an exception. In this review, we discuss advances in our understanding of genetic determinants of RA risk among global populations, with a focus on the Latin American population. Geographically restricted genetic diversity may have important implications for health and disease that will remain unknown until genetic association studies have been extended to include Latin American and other currently under-represented ancestries. The next few years will witness many breakthroughs in personalized medicine, including applications for common diseases and risk stratification instruments for targeted prevention/intervention strategies. Not all of these applications may be extrapolated from the Caucasian experience to Latin American or other under-represented populations.
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Knevel R, le Cessie S, Terao CC, Slowikowski K, Cui J, Huizinga TWJ, Costenbader KH, Liao KP, Karlson EW, Raychaudhuri S. Using genetics to prioritize diagnoses for rheumatology outpatients with inflammatory arthritis. Sci Transl Med 2020; 12:eaay1548. [PMID: 32461333 PMCID: PMC7341896 DOI: 10.1126/scitranslmed.aay1548] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 10/15/2019] [Accepted: 05/03/2020] [Indexed: 12/26/2022]
Abstract
It is challenging to quickly diagnose slowly progressing diseases. To prioritize multiple related diagnoses, we developed G-PROB (Genetic Probability tool) to calculate the probability of different diseases for a patient using genetic risk scores. We tested G-PROB for inflammatory arthritis-causing diseases (rheumatoid arthritis, systemic lupus erythematosus, spondyloarthropathy, psoriatic arthritis, and gout). After validating on simulated data, we tested G-PROB in three cohorts: 1211 patients identified by International Classification of Diseases (ICD) codes within the eMERGE database, 245 patients identified through ICD codes and medical record review within the Partners Biobank, and 243 patients first presenting with unexplained inflammatory arthritis and with final diagnoses by record review within the Partners Biobank. Calibration of G-probabilities with disease status was high, with regression coefficients from 0.90 to 1.08 (1.00 is ideal). G-probabilities discriminated true diagnoses across the three cohorts with pooled areas under the curve (95% CI) of 0.69 (0.67 to 0.71), 0.81 (0.76 to 0.84), and 0.84 (0.81 to 0.86), respectively. For all patients, at least one disease could be ruled out, and in 45% of patients, a likely diagnosis was identified with a 64% positive predictive value. In 35% of cases, the clinician's initial diagnosis was incorrect. Initial clinical diagnosis explained 39% of the variance in final disease, which improved to 51% (P < 0.0001) after adding G-probabilities. Converting genotype information before a clinical visit into an interpretable probability value for five different inflammatory arthritides could potentially be used to improve the diagnostic efficiency of rheumatic diseases in clinical practice.
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Affiliation(s)
- Rachel Knevel
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Rheumatology, Leiden University Medical Center, 2333 ZA Leiden, Netherlands
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA
| | - Saskia le Cessie
- Department of Clinical Epidemiology and Department of Biomedical Data Sciences, Leiden University Medical Center, 2333 ZA Leiden, Netherlands
| | - Chikashi C Terao
- Laboratory for Statistical and Translational Genetics, RIKEN Center for Integrative Medical Sciences, Yokohama, Kanagawa 230-0045, Japan
- Clinical Research Center, Shizuoka General Hospital, Shizuoka 230-0045, Japan
- Department of Applied Genetics, School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka 420-8527, Japan
| | - Kamil Slowikowski
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA
- Center for Data Sciences, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
- Division of Genetics, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA 02115, USA
| | - Jing Cui
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Tom W J Huizinga
- Department of Rheumatology, Leiden University Medical Center, 2333 ZA Leiden, Netherlands
| | - Karen H Costenbader
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Katherine P Liao
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA
| | - Elizabeth W Karlson
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Soumya Raychaudhuri
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA
- Center for Data Sciences, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
- Division of Genetics, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA 02115, USA
- Centre for Genetics and Genomics Versus Arthritis and Centre for Musculoskeletal Research, Manchester M13 9PL, UK
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Guderud K, Mæhlen MT, Nordang GBN, Viken MK, Andreassen BK, Molberg Ø, Flåm ST, Lie BA. Lack of Association among Peptidyl Arginine Deiminase Type 4 Autoantibodies, PADI4 Polymorphisms, and Clinical Characteristics in Rheumatoid Arthritis. J Rheumatol 2018; 45:1211-1219. [PMID: 29858238 DOI: 10.3899/jrheum.170769] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE We aimed to jointly investigate the role of antipeptidyl arginine deiminase type 4 antibodies (anti-PAD4) and polymorphisms in the PADI4 gene together with clinical variables in rheumatoid arthritis (RA). METHODS Serum IgG autoantibodies to human recombinant PAD4 were identified by DELFIA technique in 745 patients with RA (366 available from previous studies). Genotyping of PADI4 was performed using TaqMan assays in 945 patients and 1118 controls. Clinical data, anticitrullinated protein antibodies (ACPA) status, shared epitope status, and a combined genetic risk score were also available. RESULTS Anti-PAD4 antibodies were detected in 193 (26%) of 745 patients with RA; 149 (77%) of these were also ACPA-positive. No association was observed between anti-PAD4 status and clinical characteristics, PADI4 polymorphisms, or genetic risk scores after stratification for ACPA status. CONCLUSION Taken together, the results from these combined serological, genetic, and clinical analyses suggest that anti-PAD4 appears to be a bystander autoantibody with no current clinical utility in RA.
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Affiliation(s)
- Kari Guderud
- From the Department of Medical Genetics, and the Department of Immunology, University of Oslo and Oslo University Hospital; K.G. Jebsen Inflammation Research Centre, University of Oslo; Department of Rheumatology, Oslo University Hospital; Department of Rheumatology, Diakonhjemmet Hospital; Department of Research, Cancer Registry of Norway, Institute for Population-based Research, Oslo, Norway.,K. Guderud, M Pharm, Department of Medical Genetics, and the K.G. Jebsen Inflammation Research Centre, University of Oslo and Oslo University Hospital; M.T. Mæhlen, PhD, Department of Medical Genetics, University of Oslo and Oslo University Hospital, and Department of Rheumatology, Diakonhjemmet Hospital; G.B. Nordang, PhD, Department of Medical Genetics, University of Oslo and Oslo University Hospital; M.K. Viken, PhD, Department of Medical Genetics, and Department of Immunology, University of Oslo and Oslo University Hospital, and K.G. Jebsen Inflammation Research Centre; B.K. Andreassen, PhD, Department of Research, Cancer Registry of Norway, Institute for Population-Based Research; Ø. Molberg, PhD, Department of Rheumatology, Oslo University Hospital; S.T. Flåm, BS, Department of Medical Genetics, and the K.G. Jebsen Inflammation Research Centre, University of Oslo and Oslo University Hospital; B.A. Lie, PhD, Department of Medical Genetics, and Department of Immunology, University of Oslo and Oslo University Hospital, and K.G. Jebsen Inflammation Research Centre
| | - Marthe Thoresen Mæhlen
- From the Department of Medical Genetics, and the Department of Immunology, University of Oslo and Oslo University Hospital; K.G. Jebsen Inflammation Research Centre, University of Oslo; Department of Rheumatology, Oslo University Hospital; Department of Rheumatology, Diakonhjemmet Hospital; Department of Research, Cancer Registry of Norway, Institute for Population-based Research, Oslo, Norway.,K. Guderud, M Pharm, Department of Medical Genetics, and the K.G. Jebsen Inflammation Research Centre, University of Oslo and Oslo University Hospital; M.T. Mæhlen, PhD, Department of Medical Genetics, University of Oslo and Oslo University Hospital, and Department of Rheumatology, Diakonhjemmet Hospital; G.B. Nordang, PhD, Department of Medical Genetics, University of Oslo and Oslo University Hospital; M.K. Viken, PhD, Department of Medical Genetics, and Department of Immunology, University of Oslo and Oslo University Hospital, and K.G. Jebsen Inflammation Research Centre; B.K. Andreassen, PhD, Department of Research, Cancer Registry of Norway, Institute for Population-Based Research; Ø. Molberg, PhD, Department of Rheumatology, Oslo University Hospital; S.T. Flåm, BS, Department of Medical Genetics, and the K.G. Jebsen Inflammation Research Centre, University of Oslo and Oslo University Hospital; B.A. Lie, PhD, Department of Medical Genetics, and Department of Immunology, University of Oslo and Oslo University Hospital, and K.G. Jebsen Inflammation Research Centre
| | - Gry Beate Namløs Nordang
- From the Department of Medical Genetics, and the Department of Immunology, University of Oslo and Oslo University Hospital; K.G. Jebsen Inflammation Research Centre, University of Oslo; Department of Rheumatology, Oslo University Hospital; Department of Rheumatology, Diakonhjemmet Hospital; Department of Research, Cancer Registry of Norway, Institute for Population-based Research, Oslo, Norway.,K. Guderud, M Pharm, Department of Medical Genetics, and the K.G. Jebsen Inflammation Research Centre, University of Oslo and Oslo University Hospital; M.T. Mæhlen, PhD, Department of Medical Genetics, University of Oslo and Oslo University Hospital, and Department of Rheumatology, Diakonhjemmet Hospital; G.B. Nordang, PhD, Department of Medical Genetics, University of Oslo and Oslo University Hospital; M.K. Viken, PhD, Department of Medical Genetics, and Department of Immunology, University of Oslo and Oslo University Hospital, and K.G. Jebsen Inflammation Research Centre; B.K. Andreassen, PhD, Department of Research, Cancer Registry of Norway, Institute for Population-Based Research; Ø. Molberg, PhD, Department of Rheumatology, Oslo University Hospital; S.T. Flåm, BS, Department of Medical Genetics, and the K.G. Jebsen Inflammation Research Centre, University of Oslo and Oslo University Hospital; B.A. Lie, PhD, Department of Medical Genetics, and Department of Immunology, University of Oslo and Oslo University Hospital, and K.G. Jebsen Inflammation Research Centre
| | - Marte Kathrine Viken
- From the Department of Medical Genetics, and the Department of Immunology, University of Oslo and Oslo University Hospital; K.G. Jebsen Inflammation Research Centre, University of Oslo; Department of Rheumatology, Oslo University Hospital; Department of Rheumatology, Diakonhjemmet Hospital; Department of Research, Cancer Registry of Norway, Institute for Population-based Research, Oslo, Norway.,K. Guderud, M Pharm, Department of Medical Genetics, and the K.G. Jebsen Inflammation Research Centre, University of Oslo and Oslo University Hospital; M.T. Mæhlen, PhD, Department of Medical Genetics, University of Oslo and Oslo University Hospital, and Department of Rheumatology, Diakonhjemmet Hospital; G.B. Nordang, PhD, Department of Medical Genetics, University of Oslo and Oslo University Hospital; M.K. Viken, PhD, Department of Medical Genetics, and Department of Immunology, University of Oslo and Oslo University Hospital, and K.G. Jebsen Inflammation Research Centre; B.K. Andreassen, PhD, Department of Research, Cancer Registry of Norway, Institute for Population-Based Research; Ø. Molberg, PhD, Department of Rheumatology, Oslo University Hospital; S.T. Flåm, BS, Department of Medical Genetics, and the K.G. Jebsen Inflammation Research Centre, University of Oslo and Oslo University Hospital; B.A. Lie, PhD, Department of Medical Genetics, and Department of Immunology, University of Oslo and Oslo University Hospital, and K.G. Jebsen Inflammation Research Centre
| | - Bettina Kulle Andreassen
- From the Department of Medical Genetics, and the Department of Immunology, University of Oslo and Oslo University Hospital; K.G. Jebsen Inflammation Research Centre, University of Oslo; Department of Rheumatology, Oslo University Hospital; Department of Rheumatology, Diakonhjemmet Hospital; Department of Research, Cancer Registry of Norway, Institute for Population-based Research, Oslo, Norway.,K. Guderud, M Pharm, Department of Medical Genetics, and the K.G. Jebsen Inflammation Research Centre, University of Oslo and Oslo University Hospital; M.T. Mæhlen, PhD, Department of Medical Genetics, University of Oslo and Oslo University Hospital, and Department of Rheumatology, Diakonhjemmet Hospital; G.B. Nordang, PhD, Department of Medical Genetics, University of Oslo and Oslo University Hospital; M.K. Viken, PhD, Department of Medical Genetics, and Department of Immunology, University of Oslo and Oslo University Hospital, and K.G. Jebsen Inflammation Research Centre; B.K. Andreassen, PhD, Department of Research, Cancer Registry of Norway, Institute for Population-Based Research; Ø. Molberg, PhD, Department of Rheumatology, Oslo University Hospital; S.T. Flåm, BS, Department of Medical Genetics, and the K.G. Jebsen Inflammation Research Centre, University of Oslo and Oslo University Hospital; B.A. Lie, PhD, Department of Medical Genetics, and Department of Immunology, University of Oslo and Oslo University Hospital, and K.G. Jebsen Inflammation Research Centre
| | - Øyvind Molberg
- From the Department of Medical Genetics, and the Department of Immunology, University of Oslo and Oslo University Hospital; K.G. Jebsen Inflammation Research Centre, University of Oslo; Department of Rheumatology, Oslo University Hospital; Department of Rheumatology, Diakonhjemmet Hospital; Department of Research, Cancer Registry of Norway, Institute for Population-based Research, Oslo, Norway.,K. Guderud, M Pharm, Department of Medical Genetics, and the K.G. Jebsen Inflammation Research Centre, University of Oslo and Oslo University Hospital; M.T. Mæhlen, PhD, Department of Medical Genetics, University of Oslo and Oslo University Hospital, and Department of Rheumatology, Diakonhjemmet Hospital; G.B. Nordang, PhD, Department of Medical Genetics, University of Oslo and Oslo University Hospital; M.K. Viken, PhD, Department of Medical Genetics, and Department of Immunology, University of Oslo and Oslo University Hospital, and K.G. Jebsen Inflammation Research Centre; B.K. Andreassen, PhD, Department of Research, Cancer Registry of Norway, Institute for Population-Based Research; Ø. Molberg, PhD, Department of Rheumatology, Oslo University Hospital; S.T. Flåm, BS, Department of Medical Genetics, and the K.G. Jebsen Inflammation Research Centre, University of Oslo and Oslo University Hospital; B.A. Lie, PhD, Department of Medical Genetics, and Department of Immunology, University of Oslo and Oslo University Hospital, and K.G. Jebsen Inflammation Research Centre
| | - Siri Tennebø Flåm
- From the Department of Medical Genetics, and the Department of Immunology, University of Oslo and Oslo University Hospital; K.G. Jebsen Inflammation Research Centre, University of Oslo; Department of Rheumatology, Oslo University Hospital; Department of Rheumatology, Diakonhjemmet Hospital; Department of Research, Cancer Registry of Norway, Institute for Population-based Research, Oslo, Norway.,K. Guderud, M Pharm, Department of Medical Genetics, and the K.G. Jebsen Inflammation Research Centre, University of Oslo and Oslo University Hospital; M.T. Mæhlen, PhD, Department of Medical Genetics, University of Oslo and Oslo University Hospital, and Department of Rheumatology, Diakonhjemmet Hospital; G.B. Nordang, PhD, Department of Medical Genetics, University of Oslo and Oslo University Hospital; M.K. Viken, PhD, Department of Medical Genetics, and Department of Immunology, University of Oslo and Oslo University Hospital, and K.G. Jebsen Inflammation Research Centre; B.K. Andreassen, PhD, Department of Research, Cancer Registry of Norway, Institute for Population-Based Research; Ø. Molberg, PhD, Department of Rheumatology, Oslo University Hospital; S.T. Flåm, BS, Department of Medical Genetics, and the K.G. Jebsen Inflammation Research Centre, University of Oslo and Oslo University Hospital; B.A. Lie, PhD, Department of Medical Genetics, and Department of Immunology, University of Oslo and Oslo University Hospital, and K.G. Jebsen Inflammation Research Centre
| | - Benedicte Alexandra Lie
- From the Department of Medical Genetics, and the Department of Immunology, University of Oslo and Oslo University Hospital; K.G. Jebsen Inflammation Research Centre, University of Oslo; Department of Rheumatology, Oslo University Hospital; Department of Rheumatology, Diakonhjemmet Hospital; Department of Research, Cancer Registry of Norway, Institute for Population-based Research, Oslo, Norway. .,K. Guderud, M Pharm, Department of Medical Genetics, and the K.G. Jebsen Inflammation Research Centre, University of Oslo and Oslo University Hospital; M.T. Mæhlen, PhD, Department of Medical Genetics, University of Oslo and Oslo University Hospital, and Department of Rheumatology, Diakonhjemmet Hospital; G.B. Nordang, PhD, Department of Medical Genetics, University of Oslo and Oslo University Hospital; M.K. Viken, PhD, Department of Medical Genetics, and Department of Immunology, University of Oslo and Oslo University Hospital, and K.G. Jebsen Inflammation Research Centre; B.K. Andreassen, PhD, Department of Research, Cancer Registry of Norway, Institute for Population-Based Research; Ø. Molberg, PhD, Department of Rheumatology, Oslo University Hospital; S.T. Flåm, BS, Department of Medical Genetics, and the K.G. Jebsen Inflammation Research Centre, University of Oslo and Oslo University Hospital; B.A. Lie, PhD, Department of Medical Genetics, and Department of Immunology, University of Oslo and Oslo University Hospital, and K.G. Jebsen Inflammation Research Centre.
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The combined effects of cardiovascular disease related SNPs on ischemic stroke. J Neurol Sci 2018; 388:141-145. [PMID: 29627009 DOI: 10.1016/j.jns.2018.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 03/03/2018] [Accepted: 03/05/2018] [Indexed: 11/22/2022]
Abstract
PURPOSE Previous studies have revealed multiple common variants associated with known risk factors for cardiovascular disease (CVD). Ischemic stroke (IS) and CVD share several risk factors with each having substantial heritability. We aimed to generate a multi-locus genetic risk score (GRS) for IS based on CVD related SNPs to evaluate their combined effects on IS. METHODS A total of 851 patients and 977 controls were selected from Beijing, Tianjin, Shandong, Shanxi, Shaanxi and Heilongjiang communities. The candidate genes were genotyped by PCR-hybridization. Information about demographic factors, history of disease (such as hypertension), and lifestyle was obtained using structured questionnaires. A GRS model weighted by the absolute value of regression coefficient β was established to comprehensively assess the association between candidate SNPs and IS. Using the area under the receiver operating characteristic curve (AUC) to evaluate the value of GRS on predicting IS. RESULTS The GRS of cases was 2.87 ± 0.28, which was significantly higher than controls' GRS (2.78 ± 0.30) (P < 0.000). With the increase of the GRS, the risk of IS became higher (Ptrend < 0.000). Subjects in the top quartile of the GRS had about 1.9-fold increased risk of IS compared with subjects in the lowest quartile (OR adjusted = 1.880, 95%CI = 1.442-2.452, P < 0.000). The AUC = 0.580, P < 0.000. CONCLUSION 13 CVD related SNPs had combined effects on IS. The GRS of cases was significantly higher than controls' GRS. As the GRS increased, the risk of IS increased. The GRS model has some value for the prediction of IS.
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Doss J, Mo H, Carroll RJ, Crofford LJ, Denny JC. Phenome-Wide Association Study of Rheumatoid Arthritis Subgroups Identifies Association Between Seronegative Disease and Fibromyalgia. Arthritis Rheumatol 2017; 69:291-300. [PMID: 27589350 DOI: 10.1002/art.39851] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 08/11/2016] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The differences between seronegative and seropositive rheumatoid arthritis (RA) have not been widely reported. We performed electronic health record (EHR)-based phenome-wide association studies (PheWAS) to identify disease associations in seropositive and seronegative RA. METHODS A validated algorithm identified RA subjects from the de-identified version of the Vanderbilt University Medical Center EHR. Serotypes were determined by rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibody (ACPA) values. We tested EHR-derived phenotypes using PheWAS comparing seropositive RA and seronegative RA, yielding disease associations. PheWAS was also performed in RF-positive versus RF-negative subjects and ACPA-positive versus ACPA-negative subjects. Following PheWAS, select phenotypes were then manually reviewed, and fibromyalgia was specifically evaluated using a validated algorithm. RESULTS A total of 2,199 RA individuals with either RF or ACPA testing were identified. Of these, 1,382 patients (63%) were classified as seropositive. Seronegative RA was associated with myalgia and myositis (odds ratio [OR] 2.1, P = 3.7 × 10-10 ) and back pain. A manual review of the health record showed that among subjects coded for Myalgia and Myositis, ∼80% had fibromyalgia. Follow-up with a specific EHR algorithm for fibromyalgia confirmed that seronegative RA was associated with fibromyalgia (OR 1.8, P = 4.0 × 10-6 ). Seropositive RA was associated with chronic airway obstruction (OR 2.2, P = 1.4 × 10-4 ) and tobacco use (OR 2.2, P = 7.0 × 10-4 ). CONCLUSION This PheWAS of RA patients identifies a strong association between seronegativity and fibromyalgia. It also affirms relationships between seropositivity and chronic airway obstruction and between seropositivity and tobacco use. These findings demonstrate the utility of the PheWAS approach to discover novel phenotype associations within different subgroups of a disease.
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Affiliation(s)
| | - Huan Mo
- Loma Linda University Medical Center, Loma Linda, California
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Derksen VFAM, Ajeganova S, Trouw LA, van der Helm-van Mil AHM, Hafström I, Huizinga TWJ, Toes REM, Svensson B, van der Woude D. Rheumatoid arthritis phenotype at presentation differs depending on the number of autoantibodies present. Ann Rheum Dis 2016; 76:716-720. [DOI: 10.1136/annrheumdis-2016-209794] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 09/18/2016] [Accepted: 10/06/2016] [Indexed: 11/04/2022]
Abstract
ObjectivesIn rheumatoid arthritis (RA), seropositive and seronegative disease may be two entities with different underlying pathophysiological mechanisms, long-term outcomes and disease presentations. However, the effect of the conjoint presence of multiple autoantibodies, as proxy for a more pronounced humoral autoimmune response, on clinical phenotype remains unclear. Therefore, this study investigates the association between the number of autoantibodies and initial clinical presentation in two independent cohorts of patients with early RA.MethodsAutoantibody status (rheumatoid factor, anticitrullinated protein antibodies and anticarbamylated protein antibodies) was determined at baseline in the Leiden Early Arthritis Cohort (n=828) and the Swedish BARFOT (Better Anti-Rheumatic Farmaco-Therapy, n=802) study. The association between the number of autoantibodies and baseline clinical characteristics was investigated using univariable and multivariable ordinal regression.ResultsIn both cohorts, the following independent associations were found in multivariable analysis: patients with a higher number of RA-associated antibodies were younger, more often smokers, had a longer symptom duration and a higher erythrocyte sedimentation rate at presentation compared with patients with few autoantibodies.ConclusionsThe number of autoantibodies, reflecting the breadth of the humoral autoimmune response, is associated with the clinical presentation of RA. Predisease pathophysiology is thus reflected by the initial clinical phenotype.
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Márquez A, Martín J, Carmona FD. Emerging aspects of molecular biomarkers for diagnosis, prognosis and treatment response in rheumatoid arthritis. Expert Rev Mol Diagn 2016; 16:663-75. [DOI: 10.1080/14737159.2016.1174579] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Relationship between Periodontitis and Rheumatoid Arthritis: Review of the Literature. Mediators Inflamm 2015; 2015:259074. [PMID: 26347200 PMCID: PMC4539505 DOI: 10.1155/2015/259074] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 06/08/2015] [Accepted: 06/24/2015] [Indexed: 12/12/2022] Open
Abstract
Periodontitis (PD) and rheumatoid arthritis (RA) are immunoinflammatory diseases where leukocyte infiltration and inflammatory mediators induce alveolar bone loss, synovitis, and joint destruction, respectively. Thus, we reviewed the relationship between both diseases considering epidemiological aspects, mechanical periodontal treatment, inflammatory mediators, oral microbiota, and antibodies, using the keywords “periodontitis” and “rheumatoid arthritis” in PubMed database between January 2012 and March 2015, resulting in 162 articles. After critical reading based on titles and abstracts and following the inclusion and exclusion criteria, 26 articles were included. In the articles, women over 40 years old, smokers and nonsmokers, mainly constituted the analyzed groups. Eight studies broached the epidemiological relationship with PD and RA. Four trials demonstrated that the periodontal treatment influenced the severity of RA and periodontal clinical parameters. Nine studies were related with bacteria influence in the pathogenesis of RA and the presence of citrullinated proteins, autoantibodies, or rheumatoid factor in patients with PD and RA. Five studies investigated the presence of mediators of inflammation in PD and RA. In summary, the majority of the articles have confirmed that there is a correlation between PD and RA, since both disorders have characteristics in common and result from an imbalance in the immunoinflammatory response.
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Martin L, Steber WA, Lupton TL, Mahler M, Fitch CM, McMillan JD, Schmidt DR, Fritzler MJ. Clinical and serological analysis of patients with positive anticyclic citrullinated Peptide antibodies referred through a Rheumatology Central Triage System. J Rheumatol 2015; 42:771-7. [PMID: 25641884 DOI: 10.3899/jrheum.141054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2014] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Anticitrullinated protein antibodies (ACPA) are a highly specific and sensitive biomarker for the diagnosis of rheumatoid arthritis (RA). Some patients who were found to have a positive ACPA test were referred to our Rheumatology Central Triage (CT; Calgary, Alberta, Canada) for assessment by a rheumatologist. The objectives of our study were to determine the clinical accuracy of ACPA in establishing a diagnosis of RA in a real-time clinical setting. METHODS Cases that met 3 criteria were included in the study: (1) referred to the CT over 3 calendar years (n = 20,389), (2) reason for referral was a positive ACPA test (n = 568), and (3) evaluated by a certified rheumatologist (n = 314). An administrative serological database was used to retrieve specific ACPA results. RESULTS Of patients referred through our CT for evaluation of a positive ACPA test, 57.6% received a diagnosis of RA; the remainder had a variety of other diagnoses, some of which might be considered early RA (9%). The predictive values of ACPA for the diagnosis of RA were increased when rheumatoid factor (RF) results were included in the analysis. When definite and possible RA were combined and the prevalence of moderate/high ACPA was compared to all other individuals, the positive and negative predictive values for moderate/high ACPA for RA were 74.3% and 68.4%, respectively. CONCLUSION About 58% of patients with a positive ACPA referred through a triage system for a rheumatologist opinion received a diagnosis of RA at their first visit. RF provides additional useful information to guide the diagnosis and urgency of referral.
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Affiliation(s)
- Liam Martin
- From the Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada; and Inova Diagnostics Inc., San Diego, California, USA.L. Martin, MB, MRCPI, FRCPC, Professor of Medicine; W.A. Steber, BPE, BSc, Clinical Research Manager; T.L. Lupton, RN, Clinical Coordinator; C.M. Fitch, RN; J.D. McMillan, Research Assistant; D.R. Schmidt, Research Assistant; M.J. Fritzler, PhD, MD, FRCPC, Professor of Medicine, Faculty of Medicine, University of Calgary; M. Mahler, PhD, Vice-President, Research and Development, Inova Diagnostics Inc
| | - Whitney A Steber
- From the Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada; and Inova Diagnostics Inc., San Diego, California, USA.L. Martin, MB, MRCPI, FRCPC, Professor of Medicine; W.A. Steber, BPE, BSc, Clinical Research Manager; T.L. Lupton, RN, Clinical Coordinator; C.M. Fitch, RN; J.D. McMillan, Research Assistant; D.R. Schmidt, Research Assistant; M.J. Fritzler, PhD, MD, FRCPC, Professor of Medicine, Faculty of Medicine, University of Calgary; M. Mahler, PhD, Vice-President, Research and Development, Inova Diagnostics Inc
| | - Terri L Lupton
- From the Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada; and Inova Diagnostics Inc., San Diego, California, USA.L. Martin, MB, MRCPI, FRCPC, Professor of Medicine; W.A. Steber, BPE, BSc, Clinical Research Manager; T.L. Lupton, RN, Clinical Coordinator; C.M. Fitch, RN; J.D. McMillan, Research Assistant; D.R. Schmidt, Research Assistant; M.J. Fritzler, PhD, MD, FRCPC, Professor of Medicine, Faculty of Medicine, University of Calgary; M. Mahler, PhD, Vice-President, Research and Development, Inova Diagnostics Inc
| | - Michael Mahler
- From the Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada; and Inova Diagnostics Inc., San Diego, California, USA.L. Martin, MB, MRCPI, FRCPC, Professor of Medicine; W.A. Steber, BPE, BSc, Clinical Research Manager; T.L. Lupton, RN, Clinical Coordinator; C.M. Fitch, RN; J.D. McMillan, Research Assistant; D.R. Schmidt, Research Assistant; M.J. Fritzler, PhD, MD, FRCPC, Professor of Medicine, Faculty of Medicine, University of Calgary; M. Mahler, PhD, Vice-President, Research and Development, Inova Diagnostics Inc
| | - Christie M Fitch
- From the Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada; and Inova Diagnostics Inc., San Diego, California, USA.L. Martin, MB, MRCPI, FRCPC, Professor of Medicine; W.A. Steber, BPE, BSc, Clinical Research Manager; T.L. Lupton, RN, Clinical Coordinator; C.M. Fitch, RN; J.D. McMillan, Research Assistant; D.R. Schmidt, Research Assistant; M.J. Fritzler, PhD, MD, FRCPC, Professor of Medicine, Faculty of Medicine, University of Calgary; M. Mahler, PhD, Vice-President, Research and Development, Inova Diagnostics Inc
| | - Jacob D McMillan
- From the Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada; and Inova Diagnostics Inc., San Diego, California, USA.L. Martin, MB, MRCPI, FRCPC, Professor of Medicine; W.A. Steber, BPE, BSc, Clinical Research Manager; T.L. Lupton, RN, Clinical Coordinator; C.M. Fitch, RN; J.D. McMillan, Research Assistant; D.R. Schmidt, Research Assistant; M.J. Fritzler, PhD, MD, FRCPC, Professor of Medicine, Faculty of Medicine, University of Calgary; M. Mahler, PhD, Vice-President, Research and Development, Inova Diagnostics Inc
| | - Danielle R Schmidt
- From the Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada; and Inova Diagnostics Inc., San Diego, California, USA.L. Martin, MB, MRCPI, FRCPC, Professor of Medicine; W.A. Steber, BPE, BSc, Clinical Research Manager; T.L. Lupton, RN, Clinical Coordinator; C.M. Fitch, RN; J.D. McMillan, Research Assistant; D.R. Schmidt, Research Assistant; M.J. Fritzler, PhD, MD, FRCPC, Professor of Medicine, Faculty of Medicine, University of Calgary; M. Mahler, PhD, Vice-President, Research and Development, Inova Diagnostics Inc
| | - Marvin J Fritzler
- From the Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada; and Inova Diagnostics Inc., San Diego, California, USA.L. Martin, MB, MRCPI, FRCPC, Professor of Medicine; W.A. Steber, BPE, BSc, Clinical Research Manager; T.L. Lupton, RN, Clinical Coordinator; C.M. Fitch, RN; J.D. McMillan, Research Assistant; D.R. Schmidt, Research Assistant; M.J. Fritzler, PhD, MD, FRCPC, Professor of Medicine, Faculty of Medicine, University of Calgary; M. Mahler, PhD, Vice-President, Research and Development, Inova Diagnostics Inc.
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