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  • Review Article
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Defining populations at risk of rheumatoid arthritis: the first steps to prevention

Nature Reviews Rheumatology volume 10, pages 521–530 (2014)Cite this article

Subjects

Key Points

  • Disease prevention is a novel concept in rheumatoid arthritis (RA) but has been explored in other chronic diseases, with intervention at different stages of disease yielding varied results

  • Defining the stages of RA prior to overt disease and characterizing 'at-risk' populations is essential in order to develop targeted and appropriate therapies, and prevention strategies

  • At-risk individuals can be defined by their genetic, environmental, autoimmune and symptom profiles, and can possess one or several risk factors in combination

  • Intervention in the early stages of inflammatory arthritis has shown high remission rates and, furthermore, progression to RA has in some cases been delayed but not necessarily prevented

  • Population studies in autoimmune disease have demonstrated environmental and dietary risk factors for RA that might be targeted in interventional studies, similar to studies conducted in type 1 diabetes mellitus

  • Relatives of individuals who have RA, and individuals with disease-associated autoantibodies, are ideal patient cohorts for studies to gain understanding of disease pathogenesis and to explore disease-prevention strategies

Abstract

Preventing disease is a public health priority. In recent years, this focus has evolved to include noncommunicable chronic diseases such as cardiovascular disease and diabetes mellitus but is novel in rheumatic diseases such as rheumatoid arthritis (RA). In order to prevent RA, the 'at-risk' populations need to be defined. To date, a number of studies have attempted to clarify our understanding of these cohorts and how they could be identified. Suggested terminology has now been published to define individuals who might go on to develop RA. This Review considers categories of these 'at-risk' individuals, with a focus on those with systemic autoimmunity. Trials in very early RA demonstrate that disease outcomes can be reduced with early intervention. These principles are widely accepted in other diseases such as type 1 diabetes mellitus, in which steps have been taken to prevent disease in genetically predisposed individuals. Large population-based studies provide insights into potential interventions for RA prevention. By quantifying risk in different populations, the prospect of preventing this disease is feasible.

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Figure 1: Inflammatory arthritis continuum.

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Authors and Affiliations

  1. Leeds Institute of Rheumatic and Musculoskeletal Medicine, NIHR Leeds Musculoskeletal Biomedical Research Unit, University of Leeds, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK

    Laura Hunt & Paul Emery

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  1. Laura Hunt
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L.H. researched data for and wrote the article, and both authors made substantial contributions to discussion of content and review/editing of the manuscript before submission.

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Correspondence to Paul Emery.

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Competing interests

P.E. has acted as a consultant for Abbott, BMS, Chugai, MSD, Pfizer, Novartis, Roche and UCB. L.H. declares no competing interests.

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Hunt, L., Emery, P. Defining populations at risk of rheumatoid arthritis: the first steps to prevention. Nat Rev Rheumatol 10, 521–530 (2014). https://doi.org/10.1038/nrrheum.2014.82

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