Relative importance of genetic effects in rheumatoid arthritis: historical cohort study of Danish nationwide twin population  Commentary: Do genes or environment influence development of rheumatoid arthritis?

doi:10.1136/bmj.324.7332.264

BMJ 2002;324:264 ( 2 February )

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Relative importance of genetic effects in rheumatoid arthritis: historical cohort study of Danish nationwide twin population

Anders J Svendsen, specialist registrar, ^a Niels V Holm, associate professor, ^b Kirsten Kyvik, associate professor, ^c Per Hyltoft Petersen, master of science, ^d Peter Junker, professor. ^a

^a Department of Rheumatology, Odense University Hospital, 5000 Odense C, Denmark, ^b Department of Radiotherapy and Clinical Oncology, Odense University Hospital, ^c Danish Twin Registry, Department of Public Health, Epidemiology, University of Southern Denmark, Denmark, ^d Department of Clinical Chemistry, Odense University Hospital

Correspondence to: A Svendsen a.svendsen{at}winsloew.ou.dk

Objective: To determine the relative importance of environmentaland genetic effects in the development of rheumatoidarthritis.
Design: Historical cohort study with record linkagebetween a twin registry and the Danish discharge registry as wellas the Danish national registry of deaths used to estimatecompleteness.
Setting: Two population based nationwide twin birthcohorts.
Participants: 37 338 twins were sent a questionnaire aboutrheumatic diseases. Self reported rheumatoid arthritis was verifiedby clinical examination and from medicalrecords.
Main outcome measures: The probandwise concordance rate of rheumatoidarthritis in monozygotic and dizygotictwins.
Results: The response rate was 84.7%. Rheumatoid arthritiswas verified in 13 monozygotic and 36 dizygotic twins. There wereno concordant monozygotic twin pairs and two concordant dizygotictwin pairs. Based on capture-recapture methods the probabilityof ascertainment was 78.3%. The probandwise concordance rate was0 (95% confidence interval 0 to 24.7) in monozygotic twins and8.8 (1.9 to 23.7) in dizygotictwins.
Conclusion: Genes are of minor importance in the developmentof rheumatoidarthritis.

What is already known on this topic
Rheumatoid arthritis is a multifactorial disease determined by both genetic and environmental factors

Previous twin studies have shown a higher concordance for rheumatoid arthritis in monozygotic than in dizygotic twins, but the results have been biased in favour of genetic effects

What this paper adds
As concordance for rheumatoid arthritis in this study was no more common in monozygotic twins than in dizygotic twins environmental effects may be more important than genetic effects in the development of rheumatoid arthritis

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