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Genetic And Non Genetic Factors

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• Genetic and non-genetic basis
Genetic factors are relatively contributed about 50 % of the risk of the pathogenesis of RA (Aho et al., 1986; MacGregor et al., 2000). MHC encoding HLA-DRB1 gene is one of greater risk posing allele responsible for the 1/3rd of genetic basis (Deighton et al., 1989; Rigby et al., 1991). These alleles further subdivided and defined by the presence or absence of Anti-citrullinated protein antibodies (ACPA), also termed as ACPA positive RA and ACPA negative RA (Seegobin et al., 2014). ACPA positive RA more worsens the condition with severe erosive damage (Silman and Pearson, 2002). However, the non-genetic factors such as pregnancy, lifestyle, and obesity have been implicated in the development of RA (Colebatch …show more content…

However, the production of Matrix Metalloproteinase (MMP) is also responsible for the degradation of the extracellular matrix of synovium(Tan et al., 2006).
• Mineral oil and Adjuvant
Mineral oils and adjuvant have the potential to directly activate the innate immune system. Several studies have been conducted which proposed the relation between the RA with the adjuvant (Maradit-Kremers et al., 2005). The study also reported that adjuvant like BCG found to cause arthritic symptoms during the course of immunotherapy (Turesson, 2004).
• Opportunistic Infections
Microbial organisms are also responsible for activating the macrophages and leads to the development of the inflammatory mediators. However, inflammation caused by the microbial infections include Shigella, Clostridium difficile, Salmonella typhimurium, etc., called as Infectious Arthritis (Li et al., 2013).

2.7 Co-morbidity condition associated with RA
Rheumatic disorders are frequently complicated by co-existence of comorbidities. Co-morbidity is a medical condition that co-exists with the disease such as RA. A co-morbid condition in RA influences the progression and severity of disease which directly affects the quality of life, treatment of primary as well as secondary (Co-morbid) disease. There have been great chances arise due to the co-morbid condition for the social and economic burden,

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