A new window of opportunity in rheumatoid arthritis: targeting at-risk individuals

Purpose of review: Progress in our understanding of the preclinical events in rheumatoid arthritis (RA) has provided important insights into disease pathogenesis. Studying prospective cohorts of individuals at risk for RA development offers the opportunity to accurately characterize the sequence of events in preclinical disease as well as quantify the risk of different preclinical phenotypes. These data may provide the basis for preventive strategies in RA. Recent findings: RA-related systemic autoimmunity and inflammation occur long before clinical arthritis. There is growing evidence that initiating events may occur at mucosal surfaces including the periodontium, lung and gut and may be influenced by the local microbiome. For potential preventive strategies to be feasible, it is important that individuals at high risk for RA development can be readily identified from the general population. To this end, studying multiple biomarkers in prospective cohorts of at-risk individuals enables risk prediction in different at-risk phenotypes. RA prevention using immunomodulation is currently being investigated in individuals at high risk of RA development. Summary: The prospective study of at-risk individuals can provide invaluable aetiological insights as well as facilitating accurate risk prediction data. In this way, high-risk individuals may be identified for preventive interventions.