The factors of worse prognosis recognized in early RA are presented in Table 2, to which smoking has been added. The relationship between snuff and arthritis is complex and controversial: it is postulated that there would be a relationship between smoking with a higher frequency of anti-PCC autoanti-bodies and an increased risk of developing RA: and that this association would be much stronger in the carriers of genetic factors for RA Flekosteel.
On the other hand, the role of the genetic marker of RA called shared epitope, located on chromosome 6 in the HLA class II histocompatibility system complex, is associated not only with developing the disease but also with more severe forms with extra-articular manifestations.
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