Is heredity your risk factor for RA? Do you worry about passing this disease on?

My Grandfather

In the summer of 1983, I was seven and a half years old. My mother was packing to go overseas to see my grandfather. My maternal grandfather was dying and she wanted to see him before the time came. She was scheduled the next evening but when morning came, she had received news that my grandfather had passed away peacefully in his sleep. During the early morning hours, he suffered what doctors believe was a silent attack due to systemic inflammation from rheumatoid arthritis. They came to this diagnosis because he had suffered from a silent heart attack earlier that year and they were certain it was RA related.

Growing up, I often heard my mother and aunt discuss “the arthritis” my grandfather. The words “rheumatoid arthritis” was never used but they often talked about the deformity in his hands and an arthritis that confined to wheelchair for months at a time. They talked about periods of remission he had but for the most part, the disease had a significant impact on him for the nearly 20 years he suffered with it. The disease took its toll on eyes, his kidneys and eventually his heart.

I was diagnosed over 40 years after my grandfather was. People that were diagnosed back then didn’t have disease modifying drugs and biologic agents to allow them to live normal lives and keep the disease from getting worse. When I find myself feeling sorry for myself because of RA, I think about brave people like my grandfather who didn’t even have a chance of getting better or even living normal lives. He was in 40s when he was diagnosed and he spent nearly twenty years suffering and his struggle had a profound effect on his children. It was so profound that my mother and aunts still get sad when they talk about it.

Will you pass it on?

As a parent with RA, you know all too well the limitations of this disease. You hate that you have this disease, but you are glad it is you and not your partner or your children. You have so many questions about this disease but the one that stands out most to you is whether you will pass this disease on to your children.

RA affects 1 in 50 people and is three times more likely to affect women than men. It is most often diagnosed in young and middle aged adults but it can also affect children and the elderly. The exact cause is unknown but certain risk factors can increase development of the disease. As far as heredity goes, research shows that RA is not inherited, but particular genes can increase a person’s chance of developing the disease. In fact, of 100 people with a mother, father, sister or brother with RA, up to four will also develop the condition. In the general population, one in 100 people will develop RA. However, those who carry a particular gene have a higher risk of developing the disease.

With genetics and family history being risk factors, some people have a higher chance of developing the disease. Because blood tests help with diagnosis, parents often wonder whether they should get their children tested in hopes of understanding what the future might hold for their child. However, most rheumatologists do not recommend testing if children who are not showing clinical symptoms despite a parental diagnosis. This is because even though children may test positive for a rheumatoid factor or an ANA (antinuclear antibody – found in patients with an autoimmune disease, infections or chronic conditions), it does not mean that they will develop RA. In fact, the disease rate is only 0.8% compared to 0.5% of the population in persons who carry the HLA-DR4 gene (the gene linked to RA).

The bottom line is that heredity plays a small role in the development of the disease. Therefore, test your child only if he or she is showing signs and symptoms of arthritis. Do not ignore the warning signs of RA, but do not scare your children because of your own fears. I often have to remind myself that I am lucky that my diagnosis came in 2008 and not in 1988 or 1968. So much progress has come in the last 20 years and perhaps, the next twenty years might bring remission for all or a cure for this disease but for today, I am grateful for the knowledge and advancement there is out there. Of course, I continue to be hopeful for my children’s generation and for future generations

Was heritage was a risk factor for you? Do you worry about passing this disease on to your children?