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Rheumatoid Arthritis: Pathogenesis, Prediction and Prevention - An Emerging Paradigm Shift

Author

Arthritis Rheumatol. 2020 Jun 30. doi: 10.1002/art.41417. Online ahead of print.

Kevin D Deane 1, V Michael Holers 1

Author Information

1 Division of Rheumatology, University of Colorado Denver School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA.

Abstract

Rheumatoid arthritis (RA) is currently diagnosed and treated when an individual presents to health care with signs and symptoms of inflammatory arthritis (IA) as well as other features such as autoantibodies and/or imaging findings that provide sufficient confidence that the individual has RA-like IA (e.g. meeting established classification criteria) that warrants therapy. However, it is now known that there is a stage of seropositive RA during which circulating biomarkers and other factors (e.g. joint symptoms) can be used to predict if and when an individual who does not currently have IA may develop future clinically-apparent IA and classified RA. Indeed, the discovery of the 'Pre-RA' stage of seropositive disease has led to the development of several clinical trials where individuals are studied to identify ways to delay or prevent the onset of clinically-apparent IA/RA. This review will focus on several issues pertinent to understanding the prevention of RA. These include discussion of the pathogenesis of Pre-RA development, prediction of the likelihood and timing of future classified RA, and a review of completed and ongoing clinical trials in RA prevention. Furthermore, this review will discuss challenges and opportunities to be addressed to effect a paradigm shift in RA where in the near future, proactive risk assessment focused on prevention of RA will become a public health strategy in much the same manner as cardiovascular disease is managed today.