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Fonseca JE _ et al_. (2007) Contribution for new genetic markers of rheumatoid arthritis activity and severity: sequencing of the tumour necrosis factor alpha gene promoter. _Arthritis Res

Ther_ 9: R37 Raised TNF concentrations have been implicated in the pathophysiology of rheumatoid arthritis (RA), and genetic factors are thought to influence the circulating levels of TNF.

Fonseca _ et al_. analyzed the promoter area of the _TNF_ gene (where the highest genetic variability is thought to be concentrated) between the nucleotides −1318 and +49 to assess whether

clinical activity and severity of RA are influenced by _TNF_ promoter markers. The study included 491 patients (mean age 57 ± 13.3 years) who had a mean RA disease duration of 12.7 ± 10.5

years. RA activity was assessed by the Disease Activity Score and functional ability by the Health Assessment Questionnaire. Systemic manifestations, radiological damage, use of

disease-modifying antirheumatic drugs, previous joint surgeries, and work disability were also assessed. Ten single nucleotide polymorphisms (SNPs) were genotyped, but five were excluded

because they did not fall within the Hardy–Weinberg equilibrium or were monomorphisms. SNPs at −238, −308, and −857 were associated with systemic manifestations, radiological damage, work

disability and a need for joint surgery. A weak association was seen between SNPs at −863 and −238 and high Disease Activity Score, poor Health Assessment Questionnaire result and raised

rheumatoid factor concentration; these associations varied with disease duration. In patients with >10 years of disease duration, an association was found between haplotypes and

radiological progression. The authors suggest a prospective study is needed to validate their findings and to determine the value of genotyping _TNF_ promoter sequences in the assessment of

the progression of RA. RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE TNF promoter polymorphisms influence the outcome of RA. _Nat Rev Rheumatol_ 3, 366

(2007). https://doi.org/10.1038/ncprheum0518 Download citation * Issue Date: July 2007 * DOI: https://doi.org/10.1038/ncprheum0518 SHARE THIS ARTICLE Anyone you share the following link

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