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Defining and Describing Preclinical Rheumatoid Arthritis
Some people with preclinical rheumatoid arthritis may have mild aches and pains, swelling in a joint on one side of the body (but not the other), or some fatigue or malaise — or they may feel quite normal. Even so, the presence of these biomarkers suggests they’re at risk for developing full-blown rheumatoid arthritis. In fact, research suggests that the detection of these biomarkers and autoantibodies typically occurs three to five years before the onset of RA joint symptoms. RELATED: Celebrities With Rheumatoid Arthritis RELATED: 6 Rheumatoid Arthritis Signs and Symptoms
Preclinical Rheumatoid Arthritis: Who’s At Risk and Why
People who have preclinical RA often have a first-degree relative with the disease, notes John J. Cush, MD, director of the Arthritis Care and Research Center in Dallas. “There may be an environmental influence that might make someone progress from preclinical RA to getting the disease based on proven diagnostic criteria.”
Risk Factors for Preclinical Rheumatoid Arthritis
Having a first-degree relative such as a sister or mother with RA isn’t the only red flag for preclinical RA. At this point, the primary risk factors that seem to contribute to this progression include ongoing cigarette smoking, lack of exercise, obesity, older age, and being female, Deane says. Nevertheless, “it could be that some people take the first few steps toward rheumatoid arthritis but don’t eventually develop it,” he adds.
The Preclinical RA Question and Answer That Everyone Wants to Know
In fact, preclinical rheumatoid arthritis is a hot new area of research in which people who “have these biomarkers or a first-degree relative with RA are being studied to assess the triggers that lead to progression to RA or whether therapies can be used to avert the onset of RA,” says Dr. Cush, who is executive editor of RheumNow.com. “The key question that everyone would like to answer is: Does intervention in those with preclinical RA prevent the progression to RA?” Right now, the answer appears to be a resounding maybe. Other questions that experts have: What are the risks and benefits of treating preclinical RA? Which medications would best minimize harm or long-term side effects? RELATED: Rheumatoid Arthritis Treatment Transforms a Teacher and Triathlete
RA Prevention: A Potential Reversal of Misfortune
A meta-analysis published in August 2018 in the Annals of the Rheumatic Diseases found that among those with preclinical RA, early intervention with disease-modifying antirheumatic drugs (DMARDs) may significantly reduce the risk of RA onset. Meanwhile, analysis from the ongoing PRAIRI study suggests that some biologic drugs, such as Rituxan (rituximbad) and Orencia (abatacept), may prevent or delay the onset of RA in those with the preclinical form, Cush says. And a study called StopRA is investigating whether the DMARD Plaquenil (hydroxychloroquine), which is already used to treat rheumatoid arthritis, can prevent the disease in people who have high levels of anti-CCP in their blood but haven’t been diagnosed with RA. (If your blood level of anti-CCP is high but you haven’t been diagnosed with RA yet, you can participate in the study; for details, go to Stop-RA.org). RELATED: Still’s Disease, Juvenile Arthritis, and Rheumatoid Arthritis: What’s the Difference?
The Future of Rheumatoid Arthritis Prevention?
“In a few years, we may test everybody for RA risk and treat them preventively if they have biomarkers,” Deane says. But before that can happen, he adds, “studies of preclinical RA need human subjects,” which is why he encourages people who have preclinical RA to participate in research studies (consult clinicaltrials.gov for leads). RELATED: This Nail-Art Blogger Won’t Let Rheumatoid Arthritis Get in the Way In the meantime, if you’re at an elevated risk for rheumatoid arthritis because you have first-degree relatives who have the autoimmune disease, you’re of Native American descent, or you have biomarkers of RA but no symptoms, it’s wise to make healthy lifestyle changes to possibly prevent the onset of RA, Deane says. These include stopping smoking, losing excess weight, and exercising regularly. While these measures haven’t been well studied for RA prevention, they certainly fall into the “can’t hurt, might help” category, he says. “Because these measures carry broad health benefits, they make a lot of sense for people to do to reduce their risk of getting rheumatoid arthritis.” RELATED: Representing People With Rheumatoid Arthritis Is an Honor
