Origins and outcomes of rheumatoid arthritis

The origins of rheumatoid arthritis (RA) have been studied with the help of data generated from close to 2000 patients with recent onset RA, who have been followed longitudinally be means of structured surveillance programs in Swedish Rheumatology and coordinated from the Karolinska Institutet and Karolinska University Hospital.

“One interesting finding is that smoking in the context of certain genetic predispositions, increases the risk for rheumatoid arthritis in a dramatic way, i.e. a marked gene-environment interaction is present between genes and environment in RA. The findings reinforce the special need for programs aimed at cessation of smoking in individuals with RA and at risk for RA” says Lars Klareskog, Professor at Karolinska Institutet.

The outcomes of RA, and in particular the results of different treatments have also been studied with the help of longitudinal structured surveillance programs. “Here, we have been able to monitor both effects and adverse effects of conventional as well as novel “biological” therapies against RA in clinical practice. The systems have enabled us to study the prognostic value of immunologic as well as genetic factors, and thereby helped in optimising therapy for the individual patient” says Lars Klareskog.

The system for obtaining the longitudinal structured patient data has been developed together with patients at the Rheumatology Department at Karolinska University Hospital. It does now enable patients to give information of their disease via the computer to a web-based system before meeting the physician, so that both patient and physician at the consultation have access to the relevant graphically displayed data on the longitudinal disease development and the effects of different past therapies.

This system improves the quality in the meeting between the single patient and single physician, and provides at the same time an important tool for the clinical research, which enables the clinical scientist to make full use of the unique potentials that the Swedish health care system and health care data bases provide for understanding origins an outcomes of major chronic diseases.