The Arthritis and IBD Study (AIBD Study)

This study funded by the Canadian Institutes of Health Research in 2007 ($1 million) was awarded to our research group in collaboration with Dr Hani El-Gabalawy and the Arthritis Research Group at University of Manitoba and Dr. Brenda Elias of the Aboriginal Health Research Centre. We have long ago identified that First Nations have a much lower risk of having IBD (yet they may have high rates of infectious diarrhea and other intestinal disorders). Dr. El-Gabalawy and others have found that First Nations have higher rates of rheumatoid arthritis than Caucasian populations.

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So what is it about First Nations that leads to very high rates of one type of chronic immune disease (arthritis) and low rates of another (IBD)? We have enrolled nearly 1500 persons with either of rheumatoid arthritis or IBD or healthy controls and focusing on First Nations and Caucasian volunteers. We have been studying the serum and DNA of these groups to understand where the differences may lie that predispose to either developing arthritis or IBD.

Murdoch TB, Bernstein CN, El-Gabalawy H, Pathan S, Stempak J, Sargent M, Elias B, Xu W, Silverberg MS. Prevalence of genetic variants associated with inflammatory bowel disease in healthy First Nations and Caucasian cohorts. Canadian Medical Association Journal 2012; 184: 435-41.

In this study we assessed the DNA from the healthy Caucasian subjects and the healthy First Nations subjects for the gene alleles that are known to have mutations associated with IBD. We found several differences between the two ethnic groups. There was a lack of mutations for a number of known Crohn’s disease gene markers in the First Nations. This finding may contribute to our understanding as to why it is so uncommon for First Nations to develop IBD.

Bernstein CN, El-Gabalawy H, Sargent M, Landers CJ, Elias B, Targan SR. Assessing IBD-association antibodies in Caucasian and First Nation cohorts-Clue to the paucity of IBD in First Nations.Canadian Journal of Gastroenterology 2011; May 25 (5): 269-73

There are a series of antibodies that are highly associated with IBD. The antibody called pANCA is associated with ulcerative colitis. The antibodies ASCA, I2, OMP-C and CBir-1 are associated with Crohn’s disease. Since the First Nations have such low rates of IBD we would have expected them to have low rates of these antibodies especially in First Nations who do not have IBD. In this study we found the opposite. In First Nations with, rheumatoid arthritis and healthy controls we found these antibodies to be measurable in some. This study provides further evidence that these antibodies are not likely to be pathogenetic (in other words are not important in causing disease). This study was done in collaboration with Dr Stephan Targan at Cedars Sinai Medical Centre, Los Angeles, California.

Demographics and lifestyle factors among First Nations and Caucasians

We found that First Nations who are healthy have higher rates of joint complaints while Caucasians who are healthy have higher rates of bowel and abdominal pain complaints. We also found that First Nations have higher rates of dental complaints and less visits with dentists. First Nations are more likely to be smokers as well. The combination of smoking and poor oral health may pose other health risks.

Blanchard AK, Wang X, El-Gabalawy H, Tan Q, Orr P, Elias B, Rawsthorne P, Hart D, Chubey S, Bernstein CN. Oral health in a First Nations and a non-Aboriginal population in Manitoba. International Journal of Circumpolar Health 2012; 71: 17394.