Strategies to prevent rheumatoid arthritis in high-risk patients.

PURPOSE OF REVIEW: To examine potential interventions, including modification of environmental risk factors and use of pharmacologic agents, in at-risk populations to prevent progression to (or development of) rheumatoid arthritis (RA). This review is timely given the increasing interest in early intervention strategies and new opportunities to identify patients early in the pathogenesis of RA.

RECENT FINDINGS: Despite the growing literature demonstrating a link between anticitrullinated protein antibodies, synovitis, genetic and environmental risk factors such as smoking and RA, there are no studies that have evaluated the effect of modifying environmental risk factors in late preclinical RA. This article describes several studies that have evaluated the ability of pharmacologic interventions to modify outcomes in patients at risk for RA.

SUMMARY: The prevention of RA in at-risk populations is feasible; however, this will necessitate novel efforts to identify patients very early in disease development to examine the effectiveness and cost of preventive interventions.