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Rheumatoid arthritis prevention: any takers?
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  • Published on:
    Modifying risk factors to prevent RA
    • Marie Falahee, Lecturer in Behavioral Rheumatology University of Birmingham
    • Other Contributors:
      • Karim Raza, Professor of Rheumatology

    We would like to thank Prof Wilson Bautista-Molano for his interest in our Editorial and for his insightful comments on it. As Prof Bautista-Molano highlights, a number of risk factors for RA have been identified, including smoking, periodontitis and a high BMI. Data that modifying these will have major positive health benefits, including on cardiometabolic outcomes, are strong. It is also tempting to speculate that modifying these will reduce the likelihood of RA development in individuals at risk.

    In designing studies to assess this, it is important to consider when, during the development of RA, these risk factors may exert their effects. For example, data suggest that cigarette smoking may drive the development of ACPA, whereas the transition from ACPA positivity to RA may be dependent upon a different ‘second hit’ (1). If this is indeed the case, then smoking cessation would be relevant as a primary preventive strategy for RA but may be less useful (at least in the context of RA development) when employed as a secondary preventive strategy in ACPA positive individuals (2).

    Assessing the impact of lifestyle and environmental modification on RA development in seronegative first-degree relatives (FDRs) of RA patients (or seronegative individuals identified as being at high risk on the basis of specific genetic / environmental risk factors) will be challenging. A relatively low rate of RA development, and the fact that those who develop RA may not develop i...

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    Conflict of Interest:
    KR has received research funding from AbbVie and Pfizer and and honoraria/consultancy fees from AbbVie, Sanofi, Lilly, Bristol-Myers Squibb,UCB, Pfizer, Janssen and Roche Chugai

    MF declares no competing interests
  • Published on:
    Correspondence on “Rheumatoid arthritis prevention: any takers?”
    • Wilson Bautista-Molano, Rheumatologist 1. Rheumatology Section, University Hospital Fundación Santa Fe de Bogotá, Bogotá, Colombia 2. School of Dentistry, Universidad

    Correspondence on “Rheumatoid arthritis prevention: any takers?”
    We read with great and special interest the editorial recently published in Rheumatic and Musculoskeletal Diseases by Falahee and Raza. 1 The authors clearly and elegantly state the clinical context in relation to current and potential interventions aimed to delay the onset, reduce the likelihood, or mitigate the severity of rheumatoid arthritis (RA). In addition, the authors present some data based on the perspectives and preferences of individuals who had participated in clinical trials aimed to achieve RA prevention and, on the challenges, related to recruitment for the research community as well. 2
    Preventive strategies targeting RA—especially in the preclinical phases—have recently been developed. Currently, this is an exciting field of research on chronic diseases and more specifically in the field of rheumatology to delineate interventions to modify or at least to delay the onset of RA. There is information provided in the literature related to assessing therapeutic approaches based on pharmacological interventions, such as glucocorticoids, 3 methotrexate, 4 hydroxychloroquine, 5 statins, 6 B cell directed therapy 7 and T-cell co-stimulation modulation. 8
    In contrast, studies on non-pharmacological preventive strategies in high-risk populations for RA are scarce. Thus, some cohort studies are exploring the efficacy of the modification of risk factors previously established as potentia...

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    Conflict of Interest:
    None declared.