Let the genes off the hook. A family history of osteoarthritis (OA) or unspecified arthralgia was not predictive of developing rheumatoid arthritis (RA) according to a study in Sweden, reported by Diana Swift of MedPage Today.
Study Affirms Osteoarthritis Not Inheritable

“Although statistically significant familial co-aggregation was found for RA to every non-RA arthritis-related disease group—with no pronounced difference between seropositive and seronegative RA—there was no clinically meaningful association between relatives’ arthralgias or osteoarthritis and an individual’s risk of RA, ” wrote Thomas Frisell, Ph.D., of the Karolinska Institute in Solna, and his colleagues. He added that a family history of arthritis-related conditions conferred little or no additional risk.
The researchers made use of Sweden’s National Patient Register, and the country’s Multi-Generation Register to identify the first-degree relatives of index RA patients. They identified 54, 515 people with RA and 203, 141 first-degree relatives. Familial conditions studied included other inflammatory arthritis, juvenile idiopathic arthritis (JIA), spondyloarthropathies, psoriasis/psoriatic arthritis, lupus, connective tissue diseases, arthralgias, and OA.
The researchers found that the co-aggregation pattern of arthritis-related diseases was very similar for seropositive and seronegative RA. “The difference between seropositive and seronegative RA was significant for only two of the non-RA diseases—spondyloarthropathies and psoriasis/psoriatic arthritis, ” the authors wrote.
The investigators did find that some familial conditions were more strongly associated with RA. For example, a family history of juvenile idiopathic arthritis or a first-degree relative with lupus or connective tissue disease might be predictive. There were no marked differences among siblings, parents and offspring where familial risk was concerned. A consortium of Swedish research institutions sponsored the study.

Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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