Romão Vasco C, Fonseca João Eurico
Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ERN-ReCONNET), Lisbon, Portugal.
Rheumatology Research Unit, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.
Front Med (Lausanne). 2021 Nov 26;8:689698. doi: 10.3389/fmed.2021.689698. eCollection 2021.
Rheumatoid arthritis (RA) is the most common systemic inflammatory rheumatic disease. It is associated with significant burden at the patient and societal level. Extensive efforts have been devoted to identifying a potential cause for the development of RA. Epidemiological studies have thoroughly investigated the association of several factors with the risk and course of RA. Although a precise etiology remains elusive, the current understanding is that RA is a multifactorial disease, wherein complex interactions between host and environmental factors determine the overall risk of disease susceptibility, persistence and severity. Risk factors related to the host that have been associated with RA development may be divided into genetic; epigenetic; hormonal, reproductive and neuroendocrine; and comorbid host factors. In turn, environmental risk factors include smoking and other airborne exposures; microbiota and infectious agents; diet; and socioeconomic factors. In the present narrative review, aimed at clinicians and researchers in the field of RA, we provide a state-of-the-art overview of the current knowledge on this topic, focusing on recent progresses that have improved our comprehension of disease risk and development.
类风湿关节炎（RA）是最常见的全身性炎性风湿性疾病。它在患者层面和社会层面都带来了沉重负担。人们已付出大量努力来确定RA发病的潜在原因。流行病学研究已全面调查了多种因素与RA风险及病程的关联。尽管确切病因仍不明确，但目前的认识是，RA是一种多因素疾病，其中宿主因素与环境因素之间的复杂相互作用决定了疾病易感性、持续性和严重程度的总体风险。与RA发病相关的宿主风险因素可分为遗传因素、表观遗传因素、激素、生殖和神经内分泌因素以及合并的宿主因素。反过来，环境风险因素包括吸烟和其他空气传播暴露、微生物群和感染因子、饮食以及社会经济因素。在本篇针对RA领域临床医生和研究人员的叙述性综述中，我们提供了关于该主题当前知识的最新概述，重点关注那些增进了我们对疾病风险和发病理解的最新进展。
