more 18 million people worldwide suffer from rheumatoid arthritisinclude Approximately 1.5 million Americans.

Rheumatoid arthritis is an autoimmune inflammatory arthritis, meaning a person’s immune system attacks the joints, causing significant inflammation. This inflammation can cause joint pain, stiffness, and swelling, and patients often complain of feeling tired and flu-like.

Rheumatoid arthritis can cause joint damage if left untreated. However, even with treatment, this condition can cause significant disability. In very active or advanced stages of the disease, patients may have difficulty performing daily activities such as preparing meals, caring for children, and dressing themselves.

Traditionally, this condition has been treated after patients have already developed symptoms. but, growing evidence suggests this disease can be identified faster – and Maybe it will eventually be stopped.

I am a doctor specializing in rheumatoid arthritis. researcher The person who conducted the clinical trial About the treatment of this condition. I believe this research will allow us to identify people at risk for rheumatoid arthritis before it becomes fully advanced, and will allow us to find treatments to slow or prevent rheumatoid arthritis altogether. My hope is that this could change the way rheumatoid arthritis is managed in the coming years.

Detect diseases before they cause harm

Now, when a person experiencing joint pain or other symptoms of an immune attack visits a health care provider, the health care provider can make a diagnosis by examining swelling in the joints. Healthcare providers also Blood markers called autoantibodiesHelps confirm the diagnosis. Although not all rheumatoid arthritis patients have abnormal blood markers, two autoantibodies found in up to 80% of rheumatoid arthritis patients are rheumatoid factor and anti-cyclic citrullinated peptide.

However, in multiple studies, It was confirmed that he had rheumatoid arthritis. have Preclinical stage of development. This is a period of approximately 3 to 5 years or more before joint swelling begins, during which markers such as rheumatoid factor and anti-cyclic citrullinated peptide can be detected in the blood. The presence of these markers indicates that the body and organs are still functioning normally despite autoimmunity, and people at risk for rheumatoid arthritis may not yet feel sick.

Now that researchers have identified this preclinical stage, health care providers can now use markers such as autoantibodies and symptoms such as long-lasting joint stiffness in the early morning to identify people who are at risk for rheumatoid arthritis but do not yet have joint inflammation.

Currently, the only way to predict future rheumatoid arthritis is to Still in research stagealthough we are working towards established methods in this field. Tests to check the risk of rheumatoid arthritis As a routine part of healthcare. This is similar to how we assess cardiovascular disease risk through measuring cholesterol levels.

ongoing research

With advances in our ability to predict who is likely to develop rheumatoid arthritis in the future, researchers are now working to identify treatments that can delay or prevent the onset of full-blown rheumatoid arthritis.

especially, tests have been conducted among the people Positive test result for anti-cyclic citrullinated peptideor someone who has Other risk factors For rheumatoid arthritis. These risk factors include joint pain and subclinical joint inflammation. This is when an imaging test such as magnetic resonance imaging shows joint inflammation that cannot be seen by a clinician examining the joint.

To date, nearly all of these trials have used immunologic drugs commonly used to treat serious rheumatoid arthritis. methotrexate, Hydroxychloroquine and Rituximab. Researchers have been testing whether taking any of these drugs for a short period of time can lead to a permanent reset of the immune system and prevent the development of rheumatoid arthritis.

Although no drug has yet been approved to prevent rheumatoid arthritis, these studies give hope that researchers are on track to finding the right drug and the right dose and duration of that drug.

Research on the preclinical stage of rheumatoid arthritis

Several challenges must be addressed before preventive treatment becomes standard in clinical care.

First, researchers need to better understand the biology of the preclinical stage of the disease. Until recently, most studies focused on patients with full-blown arthritis, generally ignoring people at risk of developing the disease.

But now researchers can use blood markers such as anti-cyclic citrullinated peptide antibodies to identify those at risk much more easily. and ever-increasing research Number of people with this marker informing What do scientists understand? biology of Onset of rheumatoid arthritis.

In particular, it is now clear that the preclinical stage is characterized by multiple circulatory disorders. Abnormalities in the cellular immune systemautoantibodies and inflammation. Researchers hope to discover interventions that effectively target the immune system abnormalities that promote the development of rheumatoid arthritis, before patients’ joints begin to swell.

Researchers have also discovered that preclinical immune system abnormalities may originate from other parts of the body than the joints. A new idea called Mucosal origin hypothesis They argue that the initial autoimmunity of rheumatoid arthritis is caused by inflammation of the body’s mucosal surfaces, such as the gums, lungs, and intestines. According to this theory, the joints become involved only as the disease progresses.

Although further research is needed, the mucosal origin hypothesis may help explain why periodontal disease, Emphysema or other forms of lung disease and Exposure to tobacco and forest fire smoke It is a risk factor for rheumatoid arthritis. I will also explain why specific bacteria has been related to illness. Future trials targeting interventions on mucosal processes may help researchers better understand the nature of this disease.

make a prediction

However, although biomarkers such as anti-cyclic citrullinated peptide antibodies are powerful predictors of future rheumatoid arthritis, one drawback remains. This means that some people may not develop a full-blown illness even if they test positive.

Studies have shown that approximately 20% to 30% of people are positive for anti-cyclic citrullinated peptide antibodies. develop rheumatoid arthritis within 2 to 5 yearsHowever, the presence of a combination of risk factors can identify people who suffer from symptoms such as: Risk greater than 50% If symptoms developed within one year.

This makes it difficult to find participants for clinical trials to prevent rheumatoid arthritis. If we can’t predict who will get the disease, it’s difficult to know if we’re preventing it.

So far, researchers have been trying to recruit people who have already visited their health care provider with early joint symptoms of rheumatoid arthritis, but whose joints don’t yet swell. This worked well, but we believe there are far more people at risk for rheumatoid arthritis who are still untreated. Healthcare providers are not yet testing everyone for blood markers of rheumatoid arthritis, so researchers will need a large international network that can test for risk factors such as autoantibodies to identify candidates for prevention trials.

Although there is still much work to be done, it is exciting to see the field progressing toward the point where prevention may become part of routine clinical care for rheumatoid arthritis.