Is Arthritis Hereditary?

It's hard to give a simple answer to the question of whether arthritis is hereditary. Arthritis is a group of more than 100 rheumatic diseases that involve joint pain and inflammation.

Each type has different causes and risk factors. While many types carry a genetic component, genetics alone doesn't lead to the disease.

This article will look at the role of heredity in five common arthritis types, help you identify your personal risk factors, and explore treatments and preventive measures. 

Osteoarthritis 

Osteoarthritis (OA) is the most common form of arthritis. It affects more than 32.5 million American adults, according to the Centers for Disease Control and Prevention (CDC).

Symptoms

OA is sometimes called ‘wear-and-tear’ arthritis because it develops as the cartilage between joints breaks down. That leads to bone rubbing against bone. This causes:

• Pain
• Tenderness
• Stiffness
• Inflammation
• Eventually, limited range of motion

These symptoms most often strike the joints in the hands, knees, and hips.

Risk Factors

OA risk factors include:

• Getting older
• Genetics
• Obesity
• High blood sugar
• Injury or repeated stress to joints

Aging is the most consistently identified risk factor for osteoarthritis, regardless of the joint.

Your sex impacts which joints are likely to be affected. In females, it's more common in the hand and knee. In males, it's more frequent in the hip.

Genetics

Some hereditary forms of OA stem from genetic mutations related to collagen. However, most OA isn't strictly an inherited disease. It likely takes genetics plus other risk factors for you to develop it.

Having family members with osteoarthritis is also known to increase your risk. Research shows that between 40% and 65% of OA has a genetic component. The percentage is higher for hand and hip cases

Studies on identical and non-identical twins have tied certain gene variations with an increased risk of developing OA. But no single gene causes osteoarthritis. Multiple genes are involved and other factors combined with them lead to OA.

Prevention and Treatment

You may be able to delay or prevent OA by:

• Maintaining a healthy weight
• Controlling blood sugar
• Being active
• Protecting your joints

Treatment for osteoarthritis includes lifestyle changes like:

• Increasing physical activity
• Using walking support devices
• Getting physical therapy

Medications can treat OA pain and inflammation. In advanced cases, joint replacement surgery can become necessary.

Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a type of autoimmune and inflammatory arthritis. It affects more than 1.5 million Americans, or about 0.6% of the population. 

Symptoms

In this type of arthritis, the immune system mistakenly attacks healthy joint tissues. This damage can lead to problems including long-lasting chronic pain, unsteadiness, and deformity. 

The earliest RA symptoms can include:

• Fatigue
• Low-grade fever
• Inflammation
• Pain
• Loss of appetite
• Rheumatoid nodules (firm lumps under the skin of the elbows and hands)

Unlike OA, RA affects both sides of the body at once—for example, both hands or both knees. 

Risk Factors

Risk factors for rheumatoid arthritis include:

• Getting older
• Being female
• Smoking cigarettes
• Obesity
• Stress
• Genetics

Certain acute (short-term) illnesses may combine with genetics to trigger RA. These include:

• Epstein-Barr virus (EBV)
• Escherichia coli (E. coli)
• Hepatitis C virus (HCV)
• Mycobacterium
  

Genetics

The exact causes of RA are unknown. But this type of arthritis is recognized as hereditary because your risk is associated with certain genes that you're born with.

According to a comprehensive review of the genetics of RA, the heritability of is estimated at about 60%.

A significant portion—as much as 37%—is believed to be from genes related to the human leukocyte antigen (HLA) system. Those are genes that are important to the immune response.

Other genes that may be involved include:

• STAT4: Regulation and activation of the immune response
• TRAF1, C5: Linked to chronic inflammation
• PTPN22: Tied to RA's development and progression

While these gene variants are associated with RA, you can have all of them and never develop the disease. So RA is not directly inherited but has a large genetic component.

Prevention and Treatment

Experts don't know how to prevent RA. However, it may help to focus on the risk factors you have some control over. That means not smoking, maintaining a healthy weight, and learning to manage stress.

Early detection and treatment have shown promise in reducing the impact of rheumatoid arthritis on quality of life.

Medications for RA include:

• Anti-inflammatories
• Corticosteroids
• Immunosuppressants

Lifestyle changes—including a healthy diet and regular exercise—can help you manage symptoms, as well.

Psoriatic Arthritis

About 2.4 million people are estimated to have psoriatic arthritis (PsA). Like RA, it is autoimmune and inflammatory.

PsA is believed to have less of a genetic component than RA. Even so, some genes are believed to be involved.

Symptoms

Psoriatic arthritis is caused by the inflammation associated with psoriasis, a common skin condition. In psoriasis, the immune system attacks skin cells. Eventually, the inflammation can spread to other cells and tissues.

Symptoms of PsA include:

• Pain and swelling in one or more joints
• "Sausage-like" fingers and toes
• Morning stiffness
• Silvery-white patches of skin
• Pitted nails
• Fatigue
• Eye problems

It's common for skin and nail symptoms to appear before joint pain and swelling, but sometimes the arthritis comes first or occurs without skin involvement. The most likely joints to be involved are the:

• Fingers
• Wrists
• Lower back
• Knees
• Ankles
• Toes

Eventually, PsA may affect the eyes, heart, brain, and kidneys, as well.

Risk Factors

You're more likely to develop psoriatic arthritis if you have:

• Certain genetic differences
• Psoriasis, especially with fingernail/toenail involvement
• Immune system problems

Lifestyle risk factors and certain exposures can also contribute, including:

• Smoking cigarettes
• Obesity
• High levels of psychological stress
• Excessive alcohol use
• Infections including Staphylococcus aureus, Streptococcal epidermidis, periodontitis (gum disease), or human immunodeficiency virus (HIV)
• A diet high in saturated fats
• Certain medications, such as beta-blockers, lithium, antimalarials, Aldara (imiquimod), non-steroidal anti-inflammatories, interferon-α, terbafine, TNF-α inhibitors

Genetics

Genetic differences linked to PsA mostly are related to the immune system. As with RA, many variations involve the HLA complex.

Other genes associated with this disease are believed to play small roles. Still, they're believed to contribute to your risk of developing PsA.

The genetic component of PsA is weaker than that of some other arthritis types. Evidence for this is an unpredictable pattern of inheritance. Even so, 40% of people with PsA have at least one close family member with PsA or psoriasis.

Prevention and Treatment

So far, there's no cure for PsA and no known way to prevent it. However, focusing on lifestyle risk factors may help you prevent or delay it.

It might also help you manage symptoms once you have PsA. That means:

• Quit smoking
• Lose extra weight
• Avoid saturated fat in your diet
• Limit alcohol
• Protect yourself from and aggressively treat infections
• If you're high risk, talk to your healthcare provider about what medications are safest for you

Common treatments for psoriatic arthritis include:

• Anti-inflammatories
• Corticosteroids
• Immunosuppressants
• Exercise
• Heat or cold therapy
• Joint protection, including splinting
• In advanced cases, surgery
  

Ankylosing Spondylitis

Ankylosing spondylitis (AS) is a less common form of chronic autoimmune and inflammatory arthritis. It affects just under 1% of the population.

It is not a purely genetic disease, but heritability is a significant contributing factor. It’s possible for more than one family member to have AS.

Symptoms

AS causes back and hip pain and stiffness and eventually leads to vertebrae in your spine fusing together. That fusion is called ankylosis.

AS's main target is the sacroiliac (SI) joints at the base of your spine. Symptoms include:

• Dull, diffuse pain in the low back and buttocks
• Pain in other joints, including shoulders, elbows, hips, knees, and ankles
• Pain that's worse in the morning and improves with activity
• Enthesitis (inflammation where connective tissues attach to bone)
• Anterior uveitis (eye inflammation) leading to pain, blurry vision, and light sensitivity
• Fatigue
• Trouble sleeping due to pain

In advanced cases, people with AS may develop:

• Kyphosis (a "hunchback" appearance)
• Osteoporosis (weak bones)
• Heart disease
• Spinal cord compression

Risk Factors

AS risk factors include:

• Genetics
• Immune system defects
• Being male
• Being a White person
• Being between ages 17 and 35
• Exposure to certain infections and toxins
• Stress and injury to joints
• Changes to colon bacteria
• Bowel inflammation or ulcerative colitis 

Genetics

The HLA-B27 gene variant (a protein associated with the immune system) has been found in 95% of people with ankylosing spondylitis.

However, more than 60 genes are believed to be associated with the condition. Most are related to the immune system and inflammation.

The frequency of inflammatory bowel disease (IBD) in people with AS suggests a common genetic cause. 

Prevention and Treatment

So far, researchers haven't uncovered a way to prevent AS. Most AS risk factors can't be controlled. However, safeguarding your digestive health and protecting your joints from stress and injury may help.

AS is treated with:

• Immunosuppressants
• Anti-inflammatories
• Physical therapy
• In rare cases, surgery

Lifestyle changes that may help include:

• Regular exercise
• Not smoking
• Limiting alcohol
• An anti-inflammatory diet
• Maintaining a healthy weight
  

Gout

Gout is a form of inflammatory arthritis. It's not an autoimmune disease. It's caused by high levels of uric acid (a waste product) in your blood. This is called hyperuricemia.

Your body makes uric acid by breaking down chemicals in certain foods and beverages. It's usually processed by the kidneys and passed through urine.

In hyperuricemia, the body produces more uric acid than your kidneys can handle. That leads to the build-up of crystals in your joints. These crystals are long, thin, and needle-sharp.

An estimated 4% of American adults—or about 8.3 million people—are believed to have gout. Genetics plays a major role in who develops it.

Symptoms

Gout attacks are sudden and cause severe pain and inflammation. The pain is often compared to a broken bone, a severe burn, or being stabbed. While it can strike other joints, it's most common in the big toe.

Gout symptoms include:

• Sudden severe pain
• Joint swelling with redness and warmth
• Stiff joints that hurt when moved
• Mild fever
• Fatigue
• Eventually, joint deformity and limited movement

Gout can strike frequently or may only crop up once every few years. Untreated gout tends to have worse and more frequent attacks.

Risk Factors

Susceptibility to this type of arthritis is hereditary. Genetics aren't the only factor, though. Risk factors include:

• Being male
  
• Hypertension (high blood pressure)
• Congestive heart failure
• Kidney disease
• Diabetes, insulin resistance, or metabolic syndrome
• Obesity
• Drinking alcohol
• Taking diuretics (water pills)
• Physical trauma
• Frequent consumption of high-fructose products
• A diet high in purine, a substance found in certain foods

Purine-rich foods include:

• Red meat
• Organ meat
• Some seafood (anchovies, sardines, mussels, scallops, trout, tuna)

Genetics

Research has linked multiple genetic variants to gout. That includes 28 different variants that deal specifically with uric acid.

As with other forms of arthritis, some HLA genes are also implicated. Another key genetic difference affects the response to drugs that block the formation of uric acid. This can affect how people respond to gout treatment.

Some researchers predict that genetic research will pave the way for personally tailored gout treatments and lifestyle management strategies.

Treatment and Prevention

Much of treating gout is about preventing future flares. During a flare, the focus is on pain management using anti-inflammatories, including the drug colchicine.

For frequent or chronic gout, some healthcare providers prescribe:

• Aloprim/Lopurin (allopurinol)
• Uloric (febuxostat)
• Krystexxa (pegloticase)

To prevent gout attacks, it may help to:

• Eliminate purine-rich meats from your diet
• Lose weight
• Avoid alcohol
• Get regular exercise
• Protect your joints from injury
• Stop taking diuretic medications (but talk to your healthcare provider about alternatives before discontinuing any drug)

You should also work to manage any overlapping conditions that increase your risk of gout.

When To See a Healthcare Provider

Always let your healthcare provider know if you have a family history of arthritis or autoimmune disease. Watch for early warning signs such as:

• Pain
• Swelling
• Stiffness
• Redness
• Weakness
• Fatigue

It’s normal to occasionally experience these symptoms. However, it warrants a medical appointment when pain:

• Doesn’t subside on its own after a few days
• Interferes with everyday activities
• Steadily gets worse

Summary

Many forms of arthritis are, in part, influenced by your genetic makeup. No single gene is responsible for your susceptibility to any of these types. The heritability of arthritis varies by type.

Researchers believe a genetic predisposition combines with lifestyle factors and sometimes other health conditions in order to trigger arthritis. The HLA genes are associated with many types of arthritis, as are genes related to inflammation.

If you have close family members with arthritis, you may be higher risk for developing it yourself. Your healthcare provider can help you find ways to lower your risk by focusing on controllable lifestyle factors such as diet, exercise, and smoking.

A Word From Verywell

Even if you have a genetic predisposition to developing arthritis or other rheumatic diseases, you can take action to reduce your risk and disease severity. 

Early detection and treatment can play a positive role on your overall outcome. And remember that a generally healthy lifestyle may be helpful, as well.