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Setting research priorities for arthritis: the environmental perspective
1Institute of Population and Public Health, CIHR, Toronto, ON M5T 1L5, Canada.
The Journal of Rheumatology. Supplement
|January 22, 2005
Summary
Genetic factors alone are insufficient for preventing complex diseases like inflammatory arthritis. Environmental influences and genetic predispositions interact throughout life, necessitating comprehensive prevention strategies beyond simple genetic testing.
Area of Science:
- Genetics and Epidemiology
- Complex Disease Etiology
- Preventive Medicine
Background:
- Current focus on genetic advances for disease prevention may overestimate their impact on complex, multifactorial conditions.
- Most common diseases in industrialized nations, including inflammatory arthritides, result from intricate interactions between multiple genes and environmental factors.
- The etiology of inflammatory arthritides is complex, influenced by genetic predispositions and lifelong environmental exposures.
Purpose of the Study:
- To review evidence supporting the complex genetic and environmental etiology of common diseases, particularly inflammatory arthritides.
- To highlight the limitations of current genetic testing for predicting lifelong risk of complex diseases.
- To advocate for improved understanding of disease causation for more effective primary prevention strategies.
Main Methods:
- Review of epidemiological cohort studies, particularly migrant studies, to assess etiological evidence for complex diseases.
- Analysis of evidence comparing the etiological strength of migrant studies versus "twins reared apart" studies.
- Examination of factors influencing the risks, benefits, and costs of single-locus genetic tests for chronic disease prediction.
Main Results:
- Migrant epidemiological cohort studies provide strong etiological evidence for the role of environmental factors in complex diseases.
- Single-locus genetic tests for predicting lifelong risk of complex diseases often have unacceptable predictive values for the general population.
- Preventive strategies for inflammatory arthritides lag behind cardiovascular disease due to incomplete understanding of causation.
Conclusions:
- Inflammatory arthritides and other common chronic diseases arise from complex gene-environment interactions over a lifetime.
- Current single-locus genetic testing is generally unsuitable for predicting lifelong risk of complex diseases due to limitations in predictive value.
- Expert genetic counseling is crucial before genetic testing to justify costs and address potential psychological impacts.