Does a family history of RA influence the clinical presentation and treatment response in RA?

Thomas Frisell*, Saedis Saevarsdottir, Johan Askling

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

8 Citations (Scopus)

Abstract

Objectives To assess whether family history of r heumatoid arthritis (RA), among the strongest risk factors for developing RA, also carries information on the clinical presentation and treatment response. Methods The prospective Swedish Rheumatology register was linked to family history of RA, defined as diagnosed RA in any first-degree relative, ascertained through the Swedish Multi-Generation and Patient registers. Clinical presentation was examined among patients with early RA 2000-2011 (symptom onset <12 months before inclusion, N=6869), and response to methotrexate (MTX) monotherapy in the subset starting this treatment (N=4630). Response to tumour necrosis factor inhibitors (TNFi) was examined among all patients with RA starting a TNFi as the first biological diseasemodifying antirheumatic drug 2000-2011 (N=9249). Association of family history with clinical characteristics, drug survival, European League Against Rheumatism (EULAR) response and change in disease activity at3 and 6 months was estimated using linear and generalised logistic regression models. Correlation in relatives' response measures was also assessed. Results Patients with early RA with family history of RA were more often rheumatoid factor positive, but with no other clinically meaningful differences in their clinical presentation. Family history of RA did not predict response to MTX or TNFi, with the possible exception of no versus good EULAR response to TNFi at 6 months (OR=1.4, 95% CI 1.1 to 1.7). Having a relative who discontinued TNFi within a year increased the odds of doing the same (OR=3.7, 95% CI 1.8 to 7.5), although we found no significant familial correlations in change in disease activity measures. Conclusions Family history of RA did not modify the clinical presentation of RA or predict response to standard treatment with MTX or TNFi. Treatment response, particularly drug survival, may itself be familial.

Original languageEnglish
Pages (from-to)1120-1125
Number of pages6
JournalAnnals of the Rheumatic Diseases
Volume75
Issue number6
DOIs
Publication statusPublished - Jun 2016

Bibliographical note

Funding Information:
This study was supported by the Swedish Foundation for Strategic Research, Swedish Research Council, ALF funding collaboration between Karolinska Institute and Stockholm County, and the IMI funded EU project BeTheCure. Dr Frisell had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

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