Interventions to Delay RA Onset

Dr. Deane also notes that although we don’t yet have approved interventions to prevent future RA, it’s important to carefully monitor individuals who are at-risk for future disease, educate them to come back for reevaluation if their symptoms escalate and encourage risk reduction strategies, e.g., through quitting smoking and perhaps following a Mediterranean-type diet. These aren’t proven to prevent RA in trials, but they still may help with autoimmunity and have other health benefits.

Moving Forward

Drs. Holers and Deane are co-leaders of SERA (Studies of the Etiologies of Rheumatoid Arthritis). The multi-center collaboration is examining factors and pathophysiological processes leading to RA by prospectively following individuals at risk for RA, including individuals who are ACPA positive or first-degree relatives of patients with RA.

Dr. Holers notes that prior to the onset of synovial inflammation, the disease seems to be driven by mechanisms that aren’t fully identified and don’t seem to be addressed by current RA therapies, such as methotrexate, B cell depletion or hydroxychloroquine.¹⁰ Research will continue to explore therapies already approved by the U.S. Food & Drug Administration for RA in this population.

To work toward prevention on a deeper level, the field will need to learn more about this early pathophysiology and find new therapeutic strategies for intervention, a key part of the overall SERA project.

Dr. Cope also notes that researchers are beginning to explore other high-risk rheumatology populations who may benefit from a preventive approach, such as patients at high risk of developing systemic lupus erythematosus or psoriatic arthritis.

“I think the paradigm [may] change,” says Dr. Deane. “If we have the right lab tests and learn to properly understand and apply them, we [may] be able to screen people at risk for disease and intervene to stop them from getting sick in the first place.”

Ruth Jessen Hickman, MD, a graduate of the Indiana University School of Medicine, is a medical and science writer in Bloomington, Ind.

References

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