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© 1995 British Society for Rheumatology

research-article

HETEROGENEITY OF DISEASE PHENOTYPE IN MONOZYGOTIC TWINS CONCORDANT FOR RHEUMATOID ARTHRITIS

A. J. MACGREGOR*, S. BAMBER*, D. CARTHY*, J. VENCOVSKY{dagger}, R. A. MAGEED{dagger}, W. E. R. OLLIER* and A. J. SILMAN*,

*ARC Epidemiology Research Unit, University of Manchester London
{dagger}Kennedy Institute London

Correspondence to: Correspondance to: A. J. Silman, ARC Epidemiology Research Unit, Stopford Building, University of Manchester, Oxford Road, Manchester M13 9PT.

The objective of the study was to investigate the genetic contribution to the clinical expression of rheumatoid arthritis (RA) by comparison of disease features in RA-concordant monozygotic (MZ) twin pairs. Fourteen RA-concordant MZ twin pairs recruited from a nation-wide study were examined to determine the degree of similarity in: (a) age of disease onset; (b) pattern of joint involvement; (c) pattern of extra-articular disease; (d) toxic reactions to drugs; (e) disease course; and (f) serology for rheumatoid factor (RF) and antinuclear antibody. There was considerable within-pair diversity in the variables studied. Some similarity within twin pairs was observed for the ages at disease onset (R = 0.63), presence of erosive changes (kappa = 0.61) and the presence of IgM RF (R = 0.87) No important similarity was seen, however, in the pattern of joint involvement, the occurrence of extra-articular disease,adverse drugs reactions, clinical disease course and reported disability level. There is heterogeneity in the genetic contribution to the clinical expression of RA. The overall lack of similarity for the majority of clinical variables indicatesthe importance of non-genetic factors on the expression of disease.

KEY WORDS: Rheumatoid arthritis, monozygotic twins, Disease concordance


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