Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disorder that leads to significant; but health issues as well as high treatment costs. In this themed issue of Clinical Therapeutics, experts review multiple aspects of RA detection and intervention; with the overall goal of moving the field closer to developing effective preventive measures. Identifying people before they develop the disorder could significantly alter the course of disease and spare people its damaging effects.

Rheumatoid arthritis affects around 1% of the population worldwide. It leads to swollen, painful joints and can also damage other body systems; such as the skin, eyes, lungs, heart, and blood vessels. This debilitating disease results in diminished quality of life, loss of work, pain, and suffering.

It is also largely a “forever” disease from which patients with full-blown RA will suffer for the rest of their lives. While medications can control RA for many patients; very few experience a complete cure and are able to discontinue treatment. RA is an expensive disease. In the United States it currently costs around $20,000-30,000 per patient annually for treatment.

Autoimmune diseases

Guest-edited by Kevin D. Deane, MD, Ph.D., Associate Professor of Medicine, Division of Rheumatology; Department of Medicine University of Colorado Denver School of Medicine, Denver, CO, USA; and Tsang Tommy Cheung, MBBS (HK), Clinical Assistant Professor, Department of Medicine; LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, this themed issue taps into the expertise of many scientists; across the world and discusses multiple aspects of RA prevention. “These discussions will hopefully provide insights into how we can move RA forward to the point; where we are preventing disease and also give guidance; on how other autoimmune diseases could be prevent as well,” explain the Guest Editors.

Many studies are already underway to learn how to prevent RA; however, prevention of autoimmune diseases is still new territory and there is a lot to discuss and learn. “Most people are familiar with prevention for diseases such as diabetes, heart disease, or cancer,” notes Dr. Deane. “For example, it is very common for someone to have routine blood tests; which might reveal high cholesterol, a potential risk factor for a future heart attack.”

“That individual can then implement lifestyle changes like more healthful eating, smoking cessation; and more exercise, or taking a medication to lower the risk of a future heart attack. We developed these approaches for heart attack prevention through clinical trials. The RA community has learned from these approaches and similar prevention-type trials are now underway in RA,” said Dr. Deane.

Blood-based tests for rheumatoid arthritis

“Most autoimmune diseases are only identified once an individual gets ‘sick.’ For example, with RA, once someone has painful, swollen joints,” adds Dr. Cheung. “Blood-based tests can now identify individuals who are at risk before they feel sick, opening a whole new world of screening and possible prevention. Treating RA very early may allow for cheaper, safer therapies to work because once full-blown RA has developed, typically very powerful medications are needed to control disease.”

In a Commentary on the clinical burden of RA, John M. Davis III, MD, MS, Associate Professor of Medicine, Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA, makes the case that preventive approaches would greatly benefit RA patients. “There have been great advances in the development of conventional synthetic, biologic, and targeted disease-modifying antirheumatic drugs (DMARDs) to treat RA as well as strategies to use these agents to control disease-associated inflammation to the state of either low disease activity or clinical remission,” he comments.

“However, with any given treatment strategy, up to 40-60% of patients ultimately respond inadequately. Investment in developing preventive strategies is expected to lead eventually to a paradigm shift from treating disease and disease-related complications to maintaining health of people worldwide,” said Davis.