Just an interesting tidbit from the Journal of Rheumatology . . .
Visiting Consultant Clinics to Study Prevalence Rates of Juvenile Rheumatoid Arthritis and Childhood Systemic Lupus Erythematosus Across Dispersed Geographic Areas
DAVID K. KURAHARA, ANDREW GRANDINETTI, LARISSA L.A. FUJII, ANGELA A. TOKUDA, JUDITH A. GALARIO, MARIE J. HAN, MARY J. TERRELL, KARA S. YAMAMOTO, KAREN M. YAMAGA, and DONALD A. PERSON
ABSTRACT.
Objective. Visiting consultant clinics (VCC) may provide pediatric rheumatologic care to children in rural populations, but the clinical demands have not been studied. We studied whether these clinics could be effective in determining prevalence rates of rheumatic illness like juvenile rheumatoid arthritis (JRA) and childhood systemic lupus erythematosus (SLE) across large dispersed geographic areas.
Methods. The study population included children diagnosed with JRA or SLE at the only civilian pediatric rheumatology center in the State of Hawaii. Prevalence rates of these illnesses were then calculated for the urban and more rural neighbor island areas. VCC and prevalence data were calculated over a 10-year period.
Results. We found a lower prevalence of JRA in the urban area (38.3 per 100,000) when compared to the rural neighbor islands (63.2 per 100,000). However, an equivalent prevalence of SLE was found in the urban (24.0 per 100,000) and neighboring islands (21.8 per 100,000). Clinical demands increased significantly with the success of the VCC, and with an increase in pediatric rheumatologic staffing.
Conclusion. We found an increased prevalence of JRA in rural areas when compared to urban areas. Similar prevalence rates of SLE suggested the finding was not due to referral bias alone. VCC are useful to estimate disease prevalence over large areas, and therefore make it possible to identify areas at greater risk. Further investigations are needed to elucidate the possible environmental and genetic factors that may explain the regional differences in JRA prevalence. (First Release Jan 15 2007; J Rheumatol 2007;34:425–9)
This is why I find this line of investigation interesting -
From Labtestsonline.com: The cause of JRA is unknown, but it is thought to be an autoimmune disorder. The tendency to develop it may be inherited, but it is believed that a triggering event is required (bold highlighting is mine) for it to emerge. It usually begins between the ages of 2 and 5 years or between 9 and 12 years. More girls than boys develop JRA.
Triggering events can be avoided. I have Celiac - we know the trigger for this autoimmune disorder, gluten. I don't eat gluten, voila! No disease. Now, most autoimmune disorders may be from permanent damage, so avoiding the trigger once exposed may not help. (Rarely, Celiac occurs like this too, it's called Refractory Celiac and it's treated with steroids and immunosuppressants just like all other AI disorders.)
But with quirky, only partially inherited JRA, if we can match known genetic risk factors with environmental triggers, we could drastically reduce the number of (new) JRA cases.
Yay!
We've had lots of research on the genetic end. This research is easily funded and takes place in labs, in test tubes and in the slightly pointy, extremely nerdy heads of our beloved research scientists
But field research is harder to fund, as you point out is more difficult, and is less appealing to the slightly pointy, extremely nerdy heads of our beloved research scientists
So, potentially, if you're diagnosed earlier than 2, there is less of a chance that it was triggered environmentally? I'm asking because while they dxed me at 18months, they're pretty sure I'd just always had it. Know what I mean?
You did not always have it - what you did always have was the genetic predispostion, "the switch", but JRA requires a trigger to flip the switch.
The fact the you and I both were dx at 18mths doesn't mean there wasn't a trigger. Perhaps we were unlucky enough to inherit extra JRA genes (making us more vulnerable than others), or we could have been exposed to a trigger earlier than most, or both.
A child with only one or two JRA genes would probably have a later disease expression. This is true in many autoimmune disorders, including celiac. My mom spent the first three years of her life in a hospital, clinging to life. I developed some vague digestive problems that slowly progressed throughout my 30s. My mom most likely inherited (double) celiac genes through both of her parents. I inherited mine (single) only through my mom.
We have lots of data on the switch, what we don't know is what exactly, (and it could be several things, alone or in concert) that flips it. The focus of most research has been on viral or bacterial triggers (because
The ACR just posted a new page on arthritis and heredity, they don't mention JRA, darn it. http://www.rheumatology.org/public/factsheets/heredity.asp
They do say this in the JRA section tho - "It is not known what causes JRA. These conditions are not regarded as hereditary and rarely affect more than one family member. Research suggests that some children have a genetic predisposition to JRA, but develop the condition only after exposure to an infectious trigger—as yet unknown. Dietary and emotional factors do not appear to play a role in the development of JRA."
So it could potentially be ANY illness that triggered it - for example, I was quite jaundiced and suffered from constant ear infections...ding ding ding? But now I'm wondering where I would have gotten extra genetic yadda yadda for it. There's only ONE person in my family that has RA, and that's my grandpa and he didn't get it until he was old. Haha I mean, he didn't get it until he was already a grandpa!
But there could be multiple triggers, and not just infectious.
JRA and RA are similar but different disorders. In JRA adults, docs often treat JRA as RA simply because they are so similar. (And, IMHO because they're lazy.
Nor does JRA run in families, it's not that kind of inherited illness. Having one (or several) JRA "friendly" genes makes you more vulnerable to the triggers. So, yes you inheritied JRA genes (probably several) but just because you have them doesn't make you sick.
They cause weak links in your immune system's armor but you still need the "arrows", the triggers, to hit you in just the right spot and maybe several need to hit you - before you come down with an autoimmune disorder. Gene research is ongoing, they have many "suspect" genes but no positive ID yet.
Here's a news link to one of the latest discoveries, http://www.nlm.nih.gov/medlineplus/news/fullstory_44202.html
And why aren't you in medical school?
I think I tend slightly more towards the mad scientist type.
I've actually been called out before in other medical forums for making "oversimplifications". (Over)Using metaphor and analogy, etc. But hey, it's the only way I can understand it!Pshaw, that's what us patients like!! Metaphors is what we gets! Hahaha
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