**Part 2**

**Consequences and Co-Morbidities** 

186 Rheumatoid Arthritis – Etiology, Consequences and Co-Morbidities

Amos, C.I.; Ardlie, K.G.; BIRAC Consortium; Barton, A.; Bowes, J.; Brouwer, E.; Burtt, N.P.; Catanese, J.J.; Coblyn, J.; Coenen, M.J.; Costenbader, K.H.; Criswell, L.A.; Crusius, J.B.; Cui, J.; de Bakker, P.I.; De Jager, P.L.; Ding, B.; Emery, P.; Flynn, E.; Harrison, P.; Hocking, L.J.; Huizinga, T.W.; Kastner, D.L.; Ke, X.; Lee, A.T.; Liu, X.; Martin, P.; Morgan, A.W.; Padyukov, L.; Posthumus, M.D.; Radstake, T.R.; Reid, D.M.; Seielstad, M.; Seldin, F.; Shadick, N.A.; Steer, S.; Tak, P.P.; Thomson, W.; van der Helm-van Mil, A.H.; van der Horst-Bruinsma, I.E.; van der Schoot, C.E.; van Riel, P.L.; Weinblatt, M.E.; Wilson, A.G.; Wolbink, G.J.; Wordsworth, B.P.; YEAR Consortium; Wijmenga, C.; Karlson, E.W.; Toes, R.E.; de Vries, N.; Begovich, A.B.; Worthington, J.; Siminovitch, K.A.; Gregersen, P.K.; Klareskog, L., & Plenge, R.M. (2010). Genome-wide association study meta-analysis identifies seven new rheumatoid arthritis risk loci. *Nat Genet*, Vol. 42, pp. 508–14. ISSN 1061-4036. Stanczyk, J.; Pedrioli, D.M.; Brentano, F.; Sanchez-Pernaute, O.; Kolling, C.; Gay, R.E.;

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PP.; Chen, S., & Shen, N. (2009). MicroRNA-146a contributes to abnormal activation of the type I interferon pathway in human lupus by targeting the key signaling proteins. *Arthritis Rheum,* Vol. 60, No. 4 (April 2009), pp. 1065–75. ISSN 0004-3591. Thomas, G. P. & Brown, M. A. (2010). Genetics and genomics of ankylosing spondylitis. *Immunol Rev,* Vol. 233, No. 1, (January 2010), pp. 162–180. ISSN 0105-2896. Tsang, J.; Zhu, J., & van Oudenaarden, A. (2007) MicroRNA-mediated feedback and

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**11** 

*Ireland* 

Yulia Zyrianova

*University College Dublin* 

**Rheumatoid Arthritis:** 

**A Historical and Biopsychosocial Perspective** 

Rheumatoid arthritis (RA) is a relatively common, disabling, autoimmune disease that is characterized by progressive joint disorder, significant pain and functional disability. Its prevalence is estimated at 0.5 - 1.0 percent of adults worldwide (Kvein, 2004), and the

 Symmetric highly inflammatory polyarthritis of peripheral joints is the hallmark of the disease. The condition is also systemic in that it often affects many extra-articular tissues throughout the body, including skin, blood vessels, heart, lungs, and muscles. The gradual involvement of multiple joints into pathophysiological process eventually results in articular destruction, ensuing instability, deformity and collateral pain. As the pathology progresses, chronic pain and functional disability dominates one's life and lessens everyday enjoyment

Physical in nature, the disease also exacts an emotional toll that often leads to unfortunate psychiatric sequelae. It is not at all surprising that in addition to joint deformity, disability, dolour, and excess mortality, on average one in five patients with rheumatoid arthritis will

Many new insights into epidemiology, pathogenesis, outcomes measurement, and pharmacologic treatment of rheumatoid arthritis have occurred in recent years. Applications of historical analyses to the development of a cogent etiologic theory of rheumatoid arthritis have been limited to date (Entezami et al, 2011). In this chapter, the author presents the major points of evidence and conclusions that have been drawn from historical, clinical and

Although the appearance of rheumatoid arthritis was noted in radiological examination of skeletal remains of Tennessee Indians from as early as 4500 BC, we do not find documented evidence until much later. It is said that realisation of how "taxing" arthritis can be, made Roman Emperor Diocletian free his citizens with the disorder from paying taxes. The term '*rheumatism*' dates back to 1630, and is derived from the Greek '*rheumatos'* that means 'flowing'. It signified an evil humour or mucus that was thought to flow from the brain to the joints, causing inflammation, pain and deformities. Short (Short, 1974)

disease continues to cause significant morbidity and premature mortality.

**1. Introduction** 

and comforts.

experience depression.

research material in the study of rheumatic diseases.

**2. Historical conceptualisation** 

**2.1 Nosology in evolution** 
