TY - JOUR
T1 - Prevention of rheumatoid arthritis
T2 - A systematic literature review of preventive strategies in at-risk individuals
AU - Frazzei, Giulia
AU - Musters, Anne
AU - de Vries, Niek
AU - Tas, Sander W.
AU - van Vollenhoven, Ronald F.
N1 - Funding Information: This work was supported by the European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement no. 847551 (GF) . Publisher Copyright: © 2022 The Authors
PY - 2023/1
Y1 - 2023/1
N2 - 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.
AB - 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.
KW - Patient perspective
KW - Preclinical rheumatoid arthritis
KW - Preventive treatment
KW - Systematic literature review
UR - http://www.scopus.com/inward/record.url?scp=85143485627&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.autrev.2022.103217
DO - https://doi.org/10.1016/j.autrev.2022.103217
M3 - Review article
C2 - 36280095
SN - 1568-9972
VL - 22
JO - Autoimmunity Reviews
JF - Autoimmunity Reviews
IS - 1
M1 - 103217
ER -