Clinical Applicability
These risk stratification criteria were created using data from specific populations already in specialized secondary care, with the aim of improving rigor in future clinical trials. “It’s very important they be applied in the correct population,” emphasizes Dr. van der Helm-van Mil.
For example, she points out that a general practitioner would see comparatively more patients with osteoarthritis than those with arthralgia who might develop RA, and the risk criteria aren’t validated for that kind of setting. In other words, these criteria are not designed for use in the general population.
However, Dr. Deane notes that on a practical level, the tool may help inform rheumatologists’ clinical practice (e.g., during patient counseling with specific at-risk patients). “If this robust tool tells you that a person is high risk, that doesn’t mean you’ll want to use a specific therapy or make a diagnosis, but you might want to monitor them more closely,” he says.
Looking Forward
Researchers have been pursuing the goal of preventing full-blown autoimmune diseases in other settings as well. Dr. Deane points out that in the field of endocrinology, researchers have developed a therapy approved by the U.S. Food & Drug Administration, teplizumab, to delay the progression of type 1 diabetes in people who already have two positive anti-pancreatic islet antibodies but who don’t yet require daily insulin injections. Researchers are also studying it in the context of high-risk patients who don’t yet qualify for a diabetes diagnosis.14
“[These] RA risk classification criteria add to the overall push to intervene in people who are feeling unwell and seeking healthcare before they have overt joint swelling and classifiable rheumatoid arthritis,” says Dr. Mankia. “This is an incremental step toward earlier therapeutic intervention.”
The committee is working on a second aspect of the project expected to be released in 2026. In contrast to the present work, it will provide RA risk stratification criteria that can be used more at a population level in people who have one or more risk factors (e.g., first-degree relative or CCP positivity) but who have not presented to a healthcare provider with arthralgia or other musculoskeletal symptoms.
“It’s so exciting that we can even begin to predict future disease and try to prevent it,” says Dr. Deane. “Having [these] new risk stratification criteria is great because it’s moving us toward being able to do that better.”
