Rheumatoid arthritis in American Indians and Alaska Natives: A review of the literature

BACKGROUND AND OBJECTIVES An increased prevalence of rheumatoid arthritis (RA) has been reported in several American Indian and Alaska Native (AI/AN) populations. This article reviews the prevalence of RA in these populations, including clinical and serologic features. METHODS References were taken from Medline through November 2003, in addition to the Arctic Health Literature Database and the American Indian and Alaska Native Health Bibliography. RESULTS Published articles reveal an increased prevalence of RA in the Tlingit, Yakima, Pima, and Chippewa Indians. Clinically the disease in these groups is often severe, with early age of onset, high frequency of radiographic erosions, rheumatoid nodules, and positive rheumatoid factor. Studies of HLA alleles in cases and controls have found a high frequency of HLA DRB1*1402. CONCLUSIONS The increased prevalence of RA and more severe disease in specific AI/AN populations suggest an important genetic influence on the development of RA in AI/AN populations. A high frequency of specific high-risk HLA alleles in these populations may account for some of the increased risk, but other genetic factors are likely to contribute. Environmental factors have not been studied in detail, but may also play an important role. RELEVANCE Understanding the patterns and burden of disease in Al/AN populations may contribute to understanding the etiology of RA and to the development of preventive strategies. RELEVANCE Understanding the patterns and burden of disease in AI/AN populations may contribute to understanding the etiology of RA and to the development of preventive strategies.