Abstract
Effective treatments for rheumatoid arthritis (RA) are available and can lead to remission
for some patients, but most patients remain on potentially toxic and expensive medications
in the long term. Interest is increasingly turning to the disease phases preceding
the development of RA that represent opportunities for preventive interventions. At-risk
target populations include individuals with genetic and environmental risk factors,
those who have developed systemic autoimmunity, and those who have developed clinically
suspect symptoms (eg, arthralgias without synovitis, or an early arthritis). Ongoing
prospective studies will inform the development of increasingly accurate predictive
tools to identify individuals at risk of developing RA. Furthermore, a range of preventive
approaches has been suggested, including lifestyle modification (eg, smoking cessation)
and pharmacologic interventions (eg, hydroxychloroquine, methotrexate, abatacept,
rituximab) that are currently the subject of randomized controlled trials. As prediction
and prevention of RA evolve, it is increasingly likely that individuals at risk (including
asymptomatic individuals) may be faced with complex decisions about whether to accept
assessment of their risk status or to take a preventive intervention associated with
risk of serious adverse events and uncertain benefit. Acceptance of preventive medication
in other contexts can be low. For example, <25% of women at high risk of breast cancer
are willing to take preventive hormonal treatments. Actual uptake is lower still.
Patients’ beliefs and preferences predict treatment uptake and adherence. Before the
dream of preventing RA can become reality, health care providers need to understand
the perspectives of individuals in the target population and to identify barriers
and facilitators for this approach. This commentary reviews what is currently known
about the perspectives of patients and individuals at risk about predictive and preventive
approaches for RA and identifies gaps to be addressed to inform the development of
efficient preventive strategies.
Keywords
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Article info
Publication history
Published online: June 09, 2019
Accepted:
April 10,
2019
Received in revised form:
March 22,
2019
Received:
February 8,
2019
Identification
Copyright
© 2019 Published by Elsevier Inc.
