Towards Prevention of Autoantibody-positive Rheumatoid Arthritis

From Lifestyle Modification to Preventive Treatment

Danielle M. Gerlag; Jill M. Norris; Paul P. Tak


Rheumatology. 2016;55(4):607-614. 

In This Article

Rheumatoid Arthritis

RA is a prototype immune-mediated inflammatory disease manifested in multiple joints, and it is associated with more aggressive articular disease, higher frequency of extra-articular manifestations and increased mortality when autoantibodies can be detected in the serum of patients. Despite major developments in antirheumatic treatment, the disease is still associated with long-term morbidity and early mortality, causing premature death due to cardiovascular disease, analogous to type I diabetes mellitus.[1] Although progression of radiographic joint damage has declined over the last decades as a result of more effective use of DMARDs and the introduction of biologics, disease remission can still not be achieved in a significant proportion of patients,[2] leading to disability, loss of quality of life, reduced ability to work and increased health care utilization by RA patients. In socio-economic terms, RA is the most common and most important of the inflammatory rheumatic diseases, with a prevalence of ~1% of the population worldwide, estimated to increase by ~22% between 2005 and 2025 due to the ageing population.[3] The relatively high prevalence, irreversible joint damage and widespread occurrence of co-morbidities determine the huge societal impact of this disease. A therapeutic window of opportunity exists early in the course of the disease during which the introduction of aggressive antirheumatic therapy can result in a change in the course of disease, leading to protection against progressive joint destruction, prevention of disability and potential lowering of the risk of cardiovascular co-morbidity.[4,5] Conceivably, there is a preventive window of opportunity during the preclinical stages of RA.