Abstract
The typical evolution of rheumatoid arthritis (RA) is that a person with genetic risk
factors develops autoantibodies and subclinical inflammation under relevant environmental
influences, culminating in symptoms and finally clinically detectable arthritis. Because
several of these characteristics can be present before the outbreak of clinical arthritis,
it is possible to study the at-risk phase (the presence of ≥1 risk factors for RA
in an individual) with the aim of quantifying the risk for that individual. As a person
progresses through the different phases of disease development, different markers
can be used for prediction. In the early asymptomatic phase, genetics, environmental
factors, and autoantibodies are relevant, whereas in later phases additional markers,
such as symptoms and imaging, come into play, conveying the risk of not only RA but
sometimes even of imminent RA. Prediction is of limited use when not coupled with
the possibility to intervene and lower the risk of RA. There is a clear need for effective
preventive strategies that take the phase of disease development into account. On
the other hand, selecting the right persons for preventive treatment according to
their stage of disease development requires the improvement of current prediction
models and strategies. This commentary presents an overview of risk factors and their
combination into prediction models for use in different stages of RA development.
Although clear progress has been made and assuming a future with effective options
to intervene, there are still several gaps in our knowledge that need to be filled
before it is clear who should be tested and when.
Keywords
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Article info
Publication history
Published online: June 09, 2019
Accepted:
April 10,
2019
Received in revised form:
March 26,
2019
Received:
January 29,
2019
Identification
Copyright
© 2019 Published by Elsevier Inc.
