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To summarize, if the constellation of genetic factors for example, HLA-DRB1 as it has a higher affinity to bind citrullinated form of proteins [95], and perhaps other loci in different populations such as the North American population and of environmental factors smoking, concomitant infections (cross-reactivity, molecular mimicry) and also general stressors (psychological as well) is created, there is a possibility for autoimmune disease development

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