Patients with Persistent Polyclonal B-Cell Lymphocytosis Share the Symptomatic Criteria of Systemic Exertion Intolerance Disease, 2021, Morizot et al

Trish said:
That's fascinating, I didn't know that. Can you estimate what proportion of people with RA have smoking as the causal factor? And are there other known causal factors?
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My mental arithmetic suggests that about 35% of men with RA wouldn't have had it if they hadn't smoked and about 16% of women with RA. So in women the great majority got RA for other reasons. Since about three quarters people withRA are women the overall figure may be about 20%. That is presumably why it was not obvious to us in the 1980s that smoking might be a causal factor.

As far as I know there are no other significant external causal factors. The rest of the causation comes from immune genetics (HLA-DR and PNP22), having two XX chromosomes and a major random element probably due to the random nature of individual antibody generation. The random mechanism for antibody diversity is now known to make use of the same enzyme that is responsible for at least some random mutations that cause lymphomas. At various levels the immune system plays a sort of Russian roulette.
 
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