In recent years, researchers have begun exploring risk factors for the development of rheumatoid arthritis (RA), including via several interventional studies. New risk stratification criteria developed by EULAR and the ACR provide an important step toward evidence-based treatment approaches for at-risk patients, particularly for those already presenting with arthralgia.1
The Drive to Earlier Interventions
One of the participants in the recent project, Kevin D. Deane, MD, PhD, a professor of medicine in the Division of Rheumatology, University of Colorado, Aurora, notes that classification criteria already exist for people who have full-blown inflammatory arthritis that is clearly diagnosable as RA. Under current criteria, such a diagnosis requires, among other things, synovitis identifiable via physical exam in at least one joint.2
However, some individuals experience arthralgia with a clinical context suggestive of rheumatoid arthritis, but without overtly swollen joints. Other people have one or more factors that put them at risk for developing RA, such as positivity for anti-citrullinated protein antibodies (ACPA) or a first degree relative with the condition; some, but not all, also experience such arthralgia.
Dr. Kevin Deane
“We have established treatments to improve outcomes and quality of life in [patients with] RA, but very rarely are people ever cured and able to come off drugs,” says Dr. Deane. “The drugs are expensive and have toxicities, and over 50% of people don’t experience complete disease remission. So intervening at an earlier point and, hopefully, preventing disease could be greatly beneficial.”
One of the project leads is Annette H.M. van der Helm-van Mil, MD, PhD, a professor in the Department of Rheumatology at Leiden University Medical Center, The Netherlands. She notes that the disease may be more reversible at an earlier stage, before pathophysiological processes are fully established. Even in people for whom the disease may not be completely prevented, it could be delayed. Appropriate treatments may improve symptoms in people already experiencing joint pain and stiffness and reduce long-term joint damage.
Dr. Annette van der Helm-van Mil
Although overall results from interventional trials have been mixed, including negative trials for hydroxychloroquine and rituximab, some randomized controlled trials have already shown promise in this area. These include two positive trials for abatacept and a study of methotrexate that showed some benefit, especially in ACPA-negative patients.3-7
However, fully interpreting and comparing the results of these prevention trials is challenging, partly because researchers in the nascent field have defined and studied patients at risk for RA using somewhat differing criteria and approaches.
