Prevention of rheumatoid arthritis: A systematic literature review of preventive strategies in at-risk individuals

https://doi.org/10.1016/j.autrev.2022.103217Get rights and content
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Highlights

  • The preclinical at risk phase of RA may be a window of opportunity for preventive treatment.

  • No preventive treatment strategy has yet succeeded in true prevention of RA.

  • Several preventive treatment strategies have resulted in a delayed onset of RA.

  • Stratification of at-risk individuals may aid in effective preventive clinical trial design.

Abstract

Background

Rheumatoid arthritis (RA) is an autoimmune disease characterized by symmetrical peripheral polyarthritis in the hands and/or feet, leading to long-term disability if not treated effectively. RA is preceded by a preclinical phase, in which genetically predisposed individuals accumulate environmental risk factors, and during which autoimmunity develops, followed by the emergence of non-specific signs and symptoms before arthritis becomes manifest. Early treatment in at-risk individuals – i.e. before the disease is fully established – has the theoretical potential to delay or prevent disease onset, with a positive impact on both patients' life and society.

Objectives

We aimed to understand the feasibility of preventive treatment in at-risk individuals, taking into account recently performed studies and ongoing clinical trials, as well as patient perspectives.

Methods

We performed a systematic literature review (SLR) on Medline and Embase, searching articles published between 2010 and 2021 with the following key-words: “Rheumatoid arthritis”, “arthralgia”, “pre-treatment” or “prevent”.

Results

Our SLR identified a total of 1821 articles. Articles were independently screened by two researchers. A total of 14 articles were included after screening, and an additional 8 reports were manually included. We identified ten relevant clinical trials performed in at-risk individuals, or in individuals with undifferentiated inflammatory arthritis. Although no treatment was shown to prevent RA onset, early treatment with rituximab and abatacept delayed onset of full-blown RA, and both conventional and biological disease-modifying anti-rheumatic drugs (DMARDs) decreased disease-related physical limitations and increased DAS28-defined remission, at least temporarily.

Conclusions

This SLR demonstrates that early treatment of at-risk individuals may be effective in delaying RA onset, thereby decreasing disease-related limitations in individuals in the pre-clinical phase of RA. Whether this may ultimately lead to prevention of RA remains to be determined.

Keywords

Preclinical rheumatoid arthritis
Preventive treatment
Patient perspective
Systematic literature review

Data availability

No data was used for the research described in the article.

Cited by (0)

1

Equal contribution.

2

Contributed equally.