New study promises prevention of rheumatoid arthritis

More than 18 million people The whole world suffers from rheumatoid arthritisincluding nearly 1.5 million Americans.

Rheumatoid arthritis is an autoimmune inflammatory form of arthritis, which means a person’s immune system attacks their jointresulting in a large number of inflammation. This inflammation causes joint pain, stiffness, and swelling, and in many cases, patient Report fatigue and flu-like feelings.

If left untreated, rheumatoid arthritis can cause joint damage. But even with treatment, the condition can cause severe disability. in a highly active state disease or in advanced stages, patients may have difficulty performing daily tasks such as preparing food, caring for children, and dressing.

So far, patients have been treated once they develop symptoms. But there is growing evidence that the disease can be detected earlier and may even ultimately be prevented.

I am a doctor who specializes in rheumatoid arthritis and a researcher who has conducted clinical trials treat for this condition. i believe this Research The push is underway to identify people at risk of developing rheumatoid arthritis before it becomes fully developed and to find treatments that can delay or completely prevent its onset. I hope this changes the way we treat rheumatoid arthritis in the coming years.

Catching diseases before they cause harm

Currently, when someone goes to the doctor with joint pain or other symptoms of an immune attack, medical staff can make a diagnosis by checking for swollen joints. Healthcare providers will also perform tests to look for blood markers called autoantibodies, which can help confirm the diagnosis. Although not all patients with rheumatoid arthritis develop abnormal blood markers, two autoantibodies found in up to 80% of patients with rheumatoid arthritis are rheumatoid factor and anti-cyclic citrullinated peptide.

But multiple studies have now confirmed that rheumatoid arthritis is in the preclinical stages of development. This is approximately three to five years or more before joint swelling, when markers such as rheumatoid factor and anti-cyclic citrullinated peptide can be detected in the blood. The presence of these markers indicates that autoimmunity is occurring, but the body and organs are still functioning well, and people at risk for rheumatoid arthritis may not yet feel sick.

Now that researchers have identified this preclinical stage, health care providers can use markers such as autoantibodies and symptoms such as prolonged joint stiffness in the morning to identify people who are at risk for rheumatoid arthritis but who have not yet developed joint inflammation.

For now, predicting future rheumatoid arthritis remains in the research phase, although the field is working to establish ways to test for rheumatoid arthritis risk as a routine part of health care. This is similar to measuring cholesterol levels to assess cardiovascular disease risk.

ongoing research

Thanks to advances in the ability to predict who is likely to develop rheumatoid arthritis in the future, researchers are now working to find treatments that can delay or prevent full development.

In particular, trials have been conducted in people who test positive for anti-cyclic citrullinated peptide or have other risk factors for rheumatoid arthritis. These risk factors include joint pain and subclinical joint inflammation, which is joint inflammation found on imaging studies such as magnetic resonance imaging that cannot be seen when clinicians examine the joints.

To date, almost all of these trials have used immune poison Examples of drugs commonly used to treat complete rheumatoid arthritis include methotrexate, hydroxychloroquine, and rituximab. Researchers have been testing whether short courses of these drugs can lead to a lasting reset of the immune system and prevent the development of rheumatoid arthritis.

While there are currently no drugs approved to prevent rheumatoid arthritis, these studies raise hope that researchers can find the right drug, as well as the correct dose and duration of the drug.

Studying the preclinical stages of rheumatoid arthritis

There are still challenges that need to be addressed before preventive treatment becomes the norm in clinical care.

First, researchers need to better understand the biology of the preclinical stages of the disease. Until recently, most studies have focused on patients with full-blown arthritis and often ignored people at risk of developing the disease.

But now, researchers can use blood markers such as anti-cyclic citrullinated peptide antibodies to more easily identify those at risk. A growing number of studies of people with this marker are telling scientists how to understand the biology of rheumatoid arthritis development.

In particular, it is now clear that the preclinical phase is marked by multiple circulating immune system abnormalities in cells, autoantibodies, and inflammation. The hope is that researchers can find interventions that effectively target the immune system abnormalities that lead to the development of rheumatoid arthritis before patients’ joints begin to swell.

The researchers also found that abnormalities in the immune system in the preclinical stage may originate from parts of the body other than the joints. An emerging idea called the mucosal origin hypothesis suggests that early autoimmunity in rheumatoid arthritis is caused by inflammation of the body’s mucosal surfaces, such as the gums, lungs, and intestines. According to this theory, joints are affected only as the disease progresses.

More research is needed, but the mucosal origin hypothesis may help explain why periodontal disease, emphysema or other forms of lung disease, as well as exposure to tobacco or forest fire smoke, are risk factors for rheumatoid arthritis. It could also explain why certain bacteria are linked to the disease. Future trials targeting interventions in mucosal processes could help researchers better understand the nature of the disease.

make predictions

Although biomarkers such as anti-cyclic citrullinated peptide antibodies are strongly predictive of future rheumatoid arthritis, a difficulty remains: Some people who test positive never develop the full-blown disease.

Studies show that about 20 to 30 percent of people who are positive for anti-cyclic citrullinated peptide antibodies will develop rheumatoid arthritis within two to five years, although the presence of a combination of risk factors can identify people who are at greater than 50 percent risk of developing the disease within one year.

This makes finding participants in clinical trials to prevent rheumatoid arthritis difficult. If you can’t predict who will get the disease, it’s hard to know whether you are preventing it.

So far, researchers have tried to recruit patients who have developed early joint symptoms of rheumatoid arthritis but still don’t have joint swelling. This approach works well, but there may be more people at risk for rheumatoid arthritis who haven’t yet sought treatment. Because health care providers are not yet testing everyone for blood markers of rheumatoid arthritis, researchers will need a larger international network to test for risk factors such as autoantibodies to identify candidates for participation in prevention trials.

More work needs to be done, but it is exciting to see the field moving in a direction where prevention may become part of routine clinical care for rheumatoid arthritis.