Research targets arthritis among African-Americans

By Alicia Sands Lurry

The School of Medicine is one of four major academic medical centers in the southeast United States that will begin gathering data for investigators interested in the genetics of rheumatoid arthritis (RA) in African Americans. Support is being provided by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS).

NIAMS, a component of the National Institutes of Health (NIH), has awarded a research contract for the Consortium for the Longitudinal Evaluations of African Americans with Early Rheumatoid Arthritis (CLEAR) Registry to the University of Alabama-Birmingham. In addition to Emory, the other participating centers are the Medical University of South Carolina and the University of North Carolina.

The registry will provide clinical and x-ray data and DNA to help scientists analyze genetic and nongenetic factors that might predict disease course and outcomes of RA in this population. Certain genes that play a role in the immune system are associated with a tendency to develop RA.

Some individuals without these genes may develop this disease, while others who possess the genes never develop RA.

Scientists believe that some environmental factors may play a part, triggering the disease process in people whose genetic makeup makes them susceptible to RA.

There are currently no ongoing studies evaluating early RA in African Americans. African Americans are often under-represented in most clinical studies, including current observational studies of people with RA.

Participating investigator Doyt Conn, director of allergy, immunology and rheumatology and chief of rheumatology at Grady Hospital, said about 40 patients at Grady and Emory have been identified as possible study participants. He said the research is important because it will eventually help identify new treatment approaches for patients, particularly African Americans.

“The genetic factors correlated with clinical factors will help us understand rheumatoid arthritis better,” Conn said. “In addition, the genetic profile in African Americans may be different than that of whites. There are not that many RA studies that focus on African Ameri-cans, and genes and environment do play a factor. This study will provide a cross-section of genetic profiles.”

Larry Moreland, principal investigator of the CLEAR Registry, agreed. “This registry of African Americans with early RA will be critical in identifying risk factors, including genetic and environmental, that point to a more aggressive disease process,” he said. “Ultimately, the ability to identify patients very early in the disease process who might have a worse long-term outcome will allow physician to provide better treatments for these patients.”

Investigators at all four centers intend to register 600 participants. Those who participate will have been diagnosed with RA less than two years ago, and will be evaluated three times over a five-year period.

“The key is seeing them early and getting them on the appropriate treatment,” Conn said. “That’s the goal. We believe patients will function better and the incidence of surgery will decrease.”