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In a review published in , Deane and Holers summarize the current evidence for a pre-rheumatoid arthritis (RA) state. They review the risk factors for progression from pre-RA to RA, which include shared epitope, first-degree relatives with RA, positive antibodies (to citrullinated protein antigens [ACPA]), and rheumatoid factor (RF).

Published studies looking at use of current RA therapies in pre-RA to affect the natural course of the disease are reviewed. These include the PRAIRI study, which showed that rituximab could delay the onset of RA by 12 months in 25% of patients; the ongoing StopRA study, in which hydroxychloroquine is used; and APPIPRA study, in which abatacept is used.

The authors outline the potential mechanisms for progression from pre-RA to clinical RA and propose strategies for identification of and intervention for RA prevention.

These studies could have significant implications given that RA is associated with significant morbidity and healthcare costs. Interventions to prevent RA without significant risks could potentially have wide implications for clinicians as there is no clear consensus on managing these patients at this time.

Narender Annapureddy, MD, MS, is Assistant Professor of Medicine at Vanderbilt University in Nashville, Tennessee.

You can read the study here and an interview with the lead study author here.