{"title":"Rheumatoid arthritis: prediction of future clinically-apparent disease, and prevention.","authors":"Kevin D Deane","doi":"10.1097/BOR.0000000000001013","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose of review: </strong>This review discusses updates in the prediction and prevention of future rheumatoid arthritis (RA).</p><p><strong>Recent findings: </strong>In individuals with musculoskeletal symptoms and elevated antibodies to citrullinated proteins (ACPA) without clinical inflammatory arthritis (IA), a 'simple' score has a positive predictive value (PPV) of ∼28% for clinical IA/RA within 1 year, and a comprehensive score (including ultrasound) has a PPV of ∼71% for clinical RA within 5 years. Controlled clinical trials in individuals at-risk for future RA have been performed using corticosteroids, rituximab, atorvastatin, methotrexate, hydroxychloroquine and abatacept. Abatacept modestly reduced rates of incident clinical RA and imaging inflammation within the trials, rituximab delayed clinical IA, and methotrexate improved function, symptoms and imaging inflammation. Vitamin D with or without omega 3 fatty acids reduced incidence of autoimmune diseases, including RA. While not proven in controlled clinical trials, observational studies suggest exercise, weight loss and smoking cessation may reduce progression to clinical RA.</p><p><strong>Summary: </strong>Prediction and prevention of RA is advancing although there are no currently approved interventions for prevention. Future studies should include deeper evaluation of the pathophysiology of RA development to improve prediction and identify key pathways to target in future clinical trials, as well as develop infrastructure to support prevention-related research.</p>","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":null,"pages":null},"PeriodicalIF":5.2000,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10959682/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Current opinion in rheumatology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/BOR.0000000000001013","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/3/5 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"RHEUMATOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Purpose of review: This review discusses updates in the prediction and prevention of future rheumatoid arthritis (RA).
Recent findings: In individuals with musculoskeletal symptoms and elevated antibodies to citrullinated proteins (ACPA) without clinical inflammatory arthritis (IA), a 'simple' score has a positive predictive value (PPV) of ∼28% for clinical IA/RA within 1 year, and a comprehensive score (including ultrasound) has a PPV of ∼71% for clinical RA within 5 years. Controlled clinical trials in individuals at-risk for future RA have been performed using corticosteroids, rituximab, atorvastatin, methotrexate, hydroxychloroquine and abatacept. Abatacept modestly reduced rates of incident clinical RA and imaging inflammation within the trials, rituximab delayed clinical IA, and methotrexate improved function, symptoms and imaging inflammation. Vitamin D with or without omega 3 fatty acids reduced incidence of autoimmune diseases, including RA. While not proven in controlled clinical trials, observational studies suggest exercise, weight loss and smoking cessation may reduce progression to clinical RA.
Summary: Prediction and prevention of RA is advancing although there are no currently approved interventions for prevention. Future studies should include deeper evaluation of the pathophysiology of RA development to improve prediction and identify key pathways to target in future clinical trials, as well as develop infrastructure to support prevention-related research.
综述的目的:本综述讨论了预测和预防未来类风湿性关节炎(RA)的最新进展:在有肌肉骨骼症状和瓜氨酸蛋白抗体(ACPA)升高但无临床炎症性关节炎(IA)的个体中,"简单 "评分对1年内临床IA/RA的阳性预测值(PPV)为28%,综合评分(包括超声波)对5年内临床RA的阳性预测值(PPV)为71%。对未来可能患上 RA 的高危人群进行了对照临床试验,使用了皮质类固醇、利妥昔单抗、阿托伐他汀、甲氨蝶呤、羟氯喹和阿帕他赛。在试验中,阿巴他赛普适度降低了临床 RA 病发率和影像学炎症,利妥昔单抗推迟了临床 IA,而甲氨蝶呤改善了功能、症状和影像学炎症。含有或不含有欧米伽 3 脂肪酸的维生素 D 可降低包括 RA 在内的自身免疫性疾病的发病率。小结:尽管目前还没有获得批准的预防干预措施,但 RA 的预测和预防工作正在取得进展。未来的研究应包括对RA发展的病理生理学进行更深入的评估,以提高预测能力,确定未来临床试验的目标关键途径,以及开发支持预防相关研究的基础设施。
期刊介绍:
A high impact review journal which boasts an international readership, Current Opinion in Rheumatology offers a broad-based perspective on the most recent and exciting developments within the field of rheumatology. Published bimonthly, each issue features insightful editorials and high quality invited reviews covering two or three key disciplines which include vasculitis syndromes, medical physiology and rheumatic diseases, crystal deposition diseases and rheumatoid arthritis. Each discipline introduces world renowned guest editors to ensure the journal is at the forefront of knowledge development and delivers balanced, expert assessments of advances from the previous year.