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Setting Research Priorities for Arthritis:

The Environmental Perspective

JOHN W. FRANK

ABSTRACT.

Recent enthusiasm for genetic advances in prevention is out of keeping with the etiology of most common diseases of the industrialized world, including the major inflammatory arthritides. These conditions have a genetically "complex" causation, involving many genes, and strong influences of the environment, acting on our individual genetic endowments over the entire life course. Lines of evidence that this is so are reviewed - especially migrant epidemiological cohort studies, which are stronger etiological evidence than "twins reared apart" studies, since they tend to involve massive cultural and environmental change, while "holding genetic factors constant." More such studies would better inform preventive strategies for the inflammatory arthritides, which lag behind cardiovascular disease in understanding causation, and therefore primary prevention. Finally, factors are briefly reviewed that affect risks, benefits, and costs of single-locus genetic tests to predict lifelong risk of chronic diseases with complex and multifactorial determination. Both negative and positive predictive values of such tests for predicting lifetime disease occurrence are generally unacceptable for use in the general population. Expert genetic counseling is therefore important before such testing, to ensure that an appropriate family and personal history justifies these expensive tests, the "labeling" effects of which can last a lifetime. (J Rheumatol 2005;32 Suppl 72:58-61)

Key Indexing Terms:

ARTHRITIS
GENETIC SCREENING
PREVENTION AND CONTROL
EPIDEMIOLOGY

From the Institute of Population and Public Health, CIHR; University of Toronto; and Institute for Work and Health, Toronto Canada.

J. Frank, MD, CCFP, MSc, FRCPC, Scientific Director, Institute of Population and Public Health; Professor, Public Health Sciences, University of Toronto; Senior Scientist, Institute for Work and Health.

Address reprint requests to Dr. J. Frank, Institute of Population and Public Health, Banting Building, 100 College Street, Ste. 207,

Toronto, ON M5T 1L5.