All ETDs from UAB

Advisory Committee Chair

Donna K Arnett

Advisory Committee Members

Graciela S Alarcon

S Louis Bridges

Elizabeth E Brown

Gerald McGwin

David T Redden

Document Type

Dissertation

Date of Award

2010

Degree Name by School

Doctor of Philosophy (PhD) School of Public Health

Abstract

African Americans are under-represented in rheumatoid arthritis (RA) research and factors associated with the two main RA disease outcomes, radiographic damage and functional disability, have been insufficiently studied. The objective of this project was to examine such factors using data from the Consortium for the Longitudinal Evaluation of African Americans with rheumatoid arthritis (CLEAR), a longitudinal cohort of African American patients with recent onset RA. The association between baseline generalized bone mineral density and radiographic damage at 3 years disease duration was examined among 141 subjects. The total radiographic damage score at 3-years of disease duration in subjects with reduced bone density at the femoral neck was twice that in subjects with healthy bone density (p=0.0084). No association was found for lumbar spine reduced bone density with radiographic damage score. B-cells play a crucial role in the pathogenesis of RA. B-cell genetic variants associated with RA susceptibility in Caucasian and Asian populations (BANK1 variant rs10516487 and BLK variants rs13277113 and rs2736240) were not associated with autoantibody production or radiographic damage in the CLEAR subjects. To our knowledge, there has been no longitudinal study to examine physical function in African American RA patients. Our subjects reported significant functional disability at baseline and at the 3-year follow-up visit. Female sex, fatigue and functional disability at baseline were associated with 3-year disability and anti-TNF treatment was not found to influence the outcome. In summary, we replicated the association between BMD and radiographic damage in our patients despite known ethnic/racial differences in bone density and bone metabolism. The selected B-cell disease susceptibility variants were not associated with autoantibody production or radiographic damage. High levels of functional disability were reported, exceeding those reported by subjects from earlier inception cohorts when biologic agents were not yet available and disproportionate to their disease duration and the amount of structural damage. Our findings call for studies of interventions to assist African American patients with RA of recent onset to cope with the disease and advocate the conduct of racial/ethnic specific investigations involving genetic factors.

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