Department of Experimental Immunology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands; Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and immunology Center, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands.
Department of Experimental Immunology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands; Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and immunology Center, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands.
Autoimmun Rev. 2023 Jan;22(1):103217. doi: 10.1016/j.autrev.2022.103217. Epub 2022 Oct 22.
Rheumatoid arthritis (RA) is an autoimmune disease characterized by symmetrical peripheral polyarthritis in the hands and/or feet, leading to long-term disability if not treated effectively. RA is preceded by a preclinical phase, in which genetically predisposed individuals accumulate environmental risk factors, and during which autoimmunity develops, followed by the emergence of non-specific signs and symptoms before arthritis becomes manifest. Early treatment in at-risk individuals - i.e. before the disease is fully established - has the theoretical potential to delay or prevent disease onset, with a positive impact on both patients' life and society.
We aimed to understand the feasibility of preventive treatment in at-risk individuals, taking into account recently performed studies and ongoing clinical trials, as well as patient perspectives.
We performed a systematic literature review (SLR) on Medline and Embase, searching articles published between 2010 and 2021 with the following key-words: "Rheumatoid arthritis", "arthralgia", "pre-treatment" or "prevent".
Our SLR identified a total of 1821 articles. Articles were independently screened by two researchers. A total of 14 articles were included after screening, and an additional 8 reports were manually included. We identified ten relevant clinical trials performed in at-risk individuals, or in individuals with undifferentiated inflammatory arthritis. Although no treatment was shown to prevent RA onset, early treatment with rituximab and abatacept delayed onset of full-blown RA, and both conventional and biological disease-modifying anti-rheumatic drugs (DMARDs) decreased disease-related physical limitations and increased DAS28-defined remission, at least temporarily.
This SLR demonstrates that early treatment of at-risk individuals may be effective in delaying RA onset, thereby decreasing disease-related limitations in individuals in the pre-clinical phase of RA. Whether this may ultimately lead to prevention of RA remains to be determined.
类风湿关节炎（RA）是一种自身免疫性疾病，其特征为手和/或脚的对称性外周多关节炎，如果治疗不及时有效，可导致长期残疾。RA 之前有一个临床前阶段，在此阶段，遗传易感个体积累环境危险因素，在此期间会发生自身免疫，然后在关节炎出现之前出现非特异性体征和症状。在高危人群中进行早期治疗——即在疾病完全确立之前——具有延迟或预防疾病发作的理论潜力，对患者的生活和社会都有积极影响。
我们旨在了解在高危人群中进行预防性治疗的可行性，同时考虑到最近进行的研究和正在进行的临床试验以及患者的观点。
我们在 Medline 和 Embase 上进行了系统文献回顾（SLR），检索了 2010 年至 2021 年期间发表的文章，使用的关键词如下：“类风湿关节炎”、“关节炎”、“预处理”或“预防”。
我们的 SLR 共确定了 1821 篇文章。由两名研究人员独立筛选文章。经过筛选后，共有 14 篇文章被纳入，另外还有 8 份报告是手动纳入的。我们确定了在高危人群或未分化炎症性关节炎患者中进行的 10 项相关临床试验。虽然没有治疗方法显示可以预防 RA 的发病，但早期使用利妥昔单抗和阿巴西普治疗可延迟完全性 RA 的发病，而且传统和生物疾病修饰抗风湿药物（DMARDs）至少暂时减少了疾病相关的身体限制并增加了 DAS28 定义的缓解。
这项 SLR 表明，早期治疗高危人群可能有效延迟 RA 的发病，从而减少 RA 临床前阶段个体的疾病相关限制。这是否最终可以预防 RA 仍有待确定。
