Sunnybrook Research Institute, Holland Bone & Joint Research Program, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada.
Clin Ther. 2019 Jul;41(7):1355-1365. doi: 10.1016/j.clinthera.2019.04.019. Epub 2019 Jun 10.
Significant advancements have been made in the discovery of gene signatures, biomarkers, novel therapeutic targets, diagnostic tools, and risk factors that predict the development of rheumatoid arthritis (RA). There is also overwhelming evidence that treatment of early RA can prevent or alter disease progression and potentially lead to drug-free remission. Despite these advancements, there are significant challenges to identifying patients at risk of developing RA on a global scale. This commentary provides an overview of challenges related to the primary, secondary, and tertiary prevention of RA in the context of health care systems. Patient-level, provider-level, and health care system-level barriers to implementing prevention strategies are discussed. Strategies and opportunities to address these challenges, on both a local and global scale, are reported. Benefits as well as potential negative consequences that may be associated with implementation of prevention strategies for RA are discussed in the context of individuals and public health.
在发现基因标志物、生物标志物、新型治疗靶点、诊断工具和预测类风湿关节炎 (RA) 发展风险因素方面已经取得了重大进展。也有大量证据表明，早期 RA 的治疗可以预防或改变疾病进展，并可能导致无药物缓解。尽管取得了这些进展，但在全球范围内识别有发生 RA 风险的患者仍然面临重大挑战。本评论概述了在医疗保健系统背景下，RA 的一级、二级和三级预防所面临的挑战。讨论了在实施预防策略方面存在的患者层面、提供者层面和医疗保健系统层面的障碍。报告了在本地和全球范围内解决这些挑战的策略和机会。讨论了在个体和公共卫生背景下，实施 RA 预防策略可能带来的益处和潜在负面影响。
