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Kim, Choi, Sung, Lee, and Bae: Characteristics of Korean Patients with RA: A Single Center Cohort Study
Original Article

J Korean Rheum Assoc 2009;16(3):204-212.

Published online: 20 September 2009

DOI: https://doi.org/10.4078/jkra.2009.16.3.204

Characteristics of Korean Patients with RA: A Single Center Cohort Study

Yun Jung Kim, Chan-Bum Choi, Yoon-Kyoung Sung, Hyeseon Lee, Sang-Cheol Bae

Department of Rheumatology, Hospital for Rheumatic Diseases, Hanyang University, College of Medicine, Seoul, Korea

Received 28 July 2009       Revised 7 August 2009       Accepted 8 August 2009

Copyright © 2009 The Korean Rheumatism Association

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

The aim of this study is to describe the general characteristics and potential susceptibility genes of a large cohort of Korean rheumatoid arthritis (RA) patients.

Methods

After giving consent, the patients were invited to undergo a structured interview and clinical examination that were performed by rheumatologists and a specially trained research nurse. When appropriate, the information obtained by interview was supplemented by information from the patient's medical record. We reviewed the genetic studies for the subjects in the Hanyang RA cohort to investigate the genetic characteristics of Korean RA patients.

Results

The mean age of the Hanyang RA cohort was 51.6±12.4 years, and 88.1% were women. The unemployment rate was 19.6%, and 52.2% of the patients had limitation of everyday life or their work life. The mean age at the time of disease onset was 41.0±12.9 years and the duration from disease onset to initiation of treatment was 23.6±57.1 months. The smoking rate of the Hanyang RA cohort was 16.8%, and 30.8% of the patients were exposed to passive smoking. Total joint arthroplastys were performed in 158 (10.3%) patients, and the most common operation site was the knee. On the review of the genetic studies for the Hanyang RA cohort, the representative susceptibility genes for the development of RA were HLA-DRB1, PADI4, STAT4 and TRAF1-C5.

Conclusion

This data of Korean RA patients can be used as the preliminary data for important studies. Establishment of a large prospective, multicenter cohort is imperative to determine the characteristics of Korean RA, and the Hanyang RA cohort is expected to play a lead role for this.

Keywords: Rheumatoid arthritis, Cohort, Korean

References

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Fig. 1.
Regional distribution of the Hanyang RA cohort.
jkra-16-204f1.tif
Table 1.
Sociodemographic characteristics of the Hanyang RA cohort
  Total (n=1,645) Men (n=196, 11.9%) Women (n=1,449, 88.1%)
Age (yrs) (mean±SD) 51.6±12.4 54.7±13.1 51.2±12.2
Marriage status
 Single 111 (6.91%) 14 (7.29%) 97 (6.86%)
 Married 1,299 (80.8%) 171 (89.06%) 1,128 (79.77%)
 Widowed 153 (9.53%) 4 (2.08%) 149 (10.54%)
 Divorce/Separate 43 (2.68%) 3 (1.56%) 40 (2.83%)
Monthly income (US$)
 ＜1,000 390 (25.93%) 44 (24.44%) 346 (26.13%)
 1,000∼2,000 405 (26.93%) 49 (27.22%) 356 (26.89%)
 2,000∼3,000 329 (21.88%) 36 (20.00%) 293 (22.13%)
 3,000∼4,000 197 (13.1%) 26 (14.44%) 171 (12.92%)
 ≥4,000 183 (12.7%) 25 (13.89%) 158 (11.93%)
Education (yrs) (mean±SD) 10.2±4.5 Employment duration (month) 205.8±163.4
Last educational background   Occupation  
 No education 121 (7.5%)  Unemployed 318 (19.6%)
 Elementary school graduate 360 (22.4%)  Housewife 786 (48.5%)
 Middle school graduate 261 (16.2%)  Muscular laborer 45 (2.8%)
 High school graduate 506 (31.5%)  Skilled laborer 44 (2.7%)
 College graduate 325 (20.20%)  Salesman 124 (7.7%)
 Higher college graduate 35 (2.2%)  Office worker 125 (7.7%)
   Professional worker 38 (2.3%)
   Etc. 140 (8.6%)
Table 2.
Details related to smoking
  Items T, Number (%) M, Number (%) W, Number (%)
Smoking history Never 1,344 (83.2) 28 (14.51) 1,316 (92.55)
 (T=1,615, M=193, W=1,422) Ex-smoker 149 (9.2) 91 (47.15) 58 (4.08)
  Smoking 122 (7.6) 74 (38.34) 48 (3.38)
Exposure to passive smoking Yes 495 (30.8) 51 (27.42) 444 (31.29)
 (T=1,605, M=186, W=1,419) No 1,110 (69.2) 135 (72.58) 975 (68.71)
Exposure to passive smoking ≤3 days a week 88 (21.5) 3 (18.75) 85 (21.63)
 at home (T=409, M=16, W=393) ＞3 days a week 321 (78.5) 13 (81.25) 308 (78.37)
Exposure to passive smoking at the ≤3 days a week 34 (26.6) 10 (25.64) 24 (26.97)
 work place (T=128, M=39, W=89) ＞3 days a week 94 (73.4) 29 (74.36) 65 (73.03)

T: total, M: men, W: women

Table 3.
Clinical characteristics of the Hanyang RA cohort
Variables Total number   Number (%)
Functional disorder and hobbies 1,615 Doesn't interfere with daily life, work ability 366 (22.70)
Unable to perform hobby, but doesn't interfere with daily life 405 (25.10)
Unable to work, but daily life is possible 446 (27.60)
Unable to perform duties of daily life 398 (24.60)
Joint replacement 1,535 No 1,377 (89.71)
Yes 158 (10.29)
Number of joint replacement operations (percentage for total RA patients) 158 1 51 (3.32)
2 93 (6.06)
3 9 (0.59)
4 4 (0.26)
5 1 (0.07)
Site of joint replacement operation (including overlapping operations) (percentage of total RA patients) 158 THR 79 (4.76)
TKR 187 (11.26)
TER 16 (0.96)
TSR 3 (0.18)
RF 1,645 Positive 1,469 (89.30)
Negative 176 (10.70)
Radiographic severity 1,639 Stage 1 353 (21.54)
Stage 2 569 (34.72)
Stage 3 486 (29.65)
Stage 4 231 (14.09)
K-HAQ 1,604 0.9±0.6 (0∼2.88)  
K-INDEX (pain) 1,588 44.1±26.9 (0∼100)  
Age at onset (yrs) 1,641 41.0±12.9 (5∼80)  
Duration of disease (months) 1,620 126.1±103.2 (0∼597)  
Duration of treatment (months) 1,621 103.4±90.9 (0∼1,305)  
Age at initiation of treatment (yrs) 1,641 42.9±12.7 (5∼83)  
Duration from disease onset to initiation of treatment (months) 1,643 23.6±57.1 (0∼444)  

Stage 1, 2, 3 and 4 according to the radiologic criteria of Steinbrocker, et al. Stage 1 (early) RA was defined as the absence of destructive changes on radiographs, stage 2 (moderate) RA was radiographic evidence of osteoporosis, with or without slight subchondral bone destruction or slight cartilage destruction, stage 3 (severe) RA was radiographic evidence of cartilage and bone destruction, subluxation, or ulnar deviation, and stage 4 (terminal) RA was fibrous or bony ankylosis (7). THR: total hip replacement, TKR: total knee replacement, TER: total elbow replacement, TSR: total shoulder replacement, RF: rheumatoid factor, K-HAQ: K-Health assessment questionnaire, RA: rheumatoid arthritis

Table 4.
Summary of the genetic studies for the subjects in the Hanyang RA cohort
RA associated genes Patients/ Controls Allele or SNP Allele frequency (patients/controls) OR (95% CI) p-value Association among ethnic groups (Korean/Caucasian/Japanese)
HLA-DRB1 (manuscript in revision) 1,482/1,119 ∗0405 22.8/8.0 3.41 (2.86∼4.07) 2.42×10−46 (+/+/+)
∗0901 14.1/9.2 1.83 (1.53∼2.19) 4.37×10−11  
∗0401 1.7/0.7 2.75 (1.53∼4.93) 4.26×10−4  
PTPN22 (3) 1,128/1,022 rs2476601 0/0 Monomorphic (−/+/−)
PADI4 (9) 545/392 rs11203366 0.48/0.38 1.5 (1.2∼1.8) 2.3×10−5 (+/−/+)
rs11203367 0.48/0.38 1.5 (1.2∼1.8) 2.3×10−5  
rs874881 0.48/0.38 1.5 (1.2∼1.8) 2.1×10−5  
rs1748033 0.41/0.34 1.4 (1.1∼1.7) 1.1×10−5  
STAT4 (10) 1,123/1,008 rs7574865 0.39/0.33 1.27 (1.11∼1.45) 4.0×10−4 (+/+/+)
rs11889341 0.35/0.3 1.27 (1.12∼1.45) 3.0×10−4  
rs8179673 0.39/0.34 1.22 (1.07∼1.38) 2.0×10−3  
rs10181656 0.39/0.34 1.21 (1.07∼1.37) 2.9×10−3  
TRAF1-C5 (11) 1,316/1,006 rs7021206 0.30/0.26 1.21 (1.06∼1.38) 0.0037 (+/+/+)

SNP: single nucleotide polymorphism, OR: odds ratio, CI: confidence interval, RA: rheumatoid arthritis

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