Rheumatoid Arthritis

We don't know what causes rheumatoid arthritis (RA) or why it affects some people but not others. It seems that complex interactions between biological and environmental factors are involved. It is probable that some of the genes that play a part in the immune system are linked to this condition. However, researchers think that something must trigger the disease in those who have a genetic susceptibility to RA. Triggers are considered to include stress, hormonal change or a form of infection.

People had lots of different ideas about what might cause rheumatoid arthritis, but many said they did not think there was an accepted cause. The role of family history, or genetics, was the source of the greatest disagreement. Some insisted that there was a connection - a belief encouraged by the number of times clinicians had asked them whether relatives had the disease, but others had read or been told that family history has no effect.

Some people were surprised to have been diagnosed because they did not think they had it 'in the family', but sometimes enquiries suggested that there were relatives with RA. A woman who was aware of auto-immune disease in her family doubted research suggesting there was no hereditary link. Others suggested a possible connection between different diseases such as MS, cancer, asthma or other auto-immune diseases.

The damp British climate was often mentioned as a possible cause. One person said that RA is now ' the British disease' and another commented that it does not seem to be very common in countries such as Japan and China, suggesting that climate, diet or some cultural factors might be important.

Several people believed that a combination of factors cause RA - for example there might be a genetic predisposition but it would take some sort of 'trigger' for the disease to appear. Triggers were sometimes thought to be a virus, trauma, multiple vaccinations or heavy manual work or a shock such as bereavement. Another person was convinced that her RA was brought on by a dreadful combination of bereavement and shock.

People who thought that there might be a gene in their family that linked to RA often voiced concern about their children or younger relatives. One woman had warned her daughters to be aware of the symptoms so that they could get early treatment and avoid joint damage.

People often suggest that stress has caused illness, although there is little evidence that it does. Sometimes the illness had appeared during exhaustion or over- exertion, for example one person had just taken part in some gruelling training. Two women thought that RA might be caused by a hormone imbalance.

Some people were dismayed that so little is known about the causes or suggested that if we knew what caused RA we'd be further along with finding a cure. Many said they were willing to share their ideas about causes with doctors and researchers and suggested that it would be useful for patients to let doctors know their theories about what might have caused their disease so that they could look for patterns and know what to investigate in future research. One pointed out that they could easily help research by filling in questionnaires while sitting around waiting for clinic appointments.

Few people thought anything could be done to prevent RA and, unlike other diseases, it wasn't widely believed to be linked to a preventable cause such as smoking or a poor diet. One man concluded that whatever the cause you just have to contend with it as best you can and a woman mentioned her reluctance to pursue ideas about causes too far in case it turned out that something she enjoyed doing was responsible. Another said that even though she was tempted to ask 'why me?' she didn't want to blame her parents or God for her disease.