The recipient of the 2015 CRA Distinguished Investigator award, Dr. Hani El-Gabalawy, from the University of Manitoba, presented his keynote address “Preventing Rheumatoid Arthritis: What we'll need to know before we start navigating this uncharted territory.”
During his lecture, Dr. El-Gabalawy discussed the intersection between genetics and the environment in the development of RA, with a focus on his research of a cohort of Aboriginal North Americans at high risk for the development of RA. He discussed a case of an individual at high risk for RA who was followed prospectively and a few years and subsequently became positive for RF, anti-CCP and anti-Sa. A few years later, she developed RA during the post-partum period.
Regarding genetics and the development of RA, Dr. El-Gabalawy discussed that multiple genes contribute, but HLA DRB1 contributes the most. Only 16% of the genetic risk for RA development has been accounted for by genome-wide association studies to date. Twin studies suggest that 50% of the risk for developing RA risk is genetic. Where is the hidden risk that we have not yet identified?
The evidence for the risks associated with environmental factors including, but not limited to smoking, periodontal disease, dusts and air pollution and their influences on the development of ACPA and RA was reviewed.
To close his lecture, Dr. El-Gabalawy challenged us on what we need to know before we can prevent RA and other autoimmune diseases. We need further research in clinical medicine, biology, psychology and sociology, public health and health economics.