Wu Tong, Li Yanhong, Liu Yi, Chu Cong-Qiu
Department of Rheumatology and Immunology, Laboratory of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.
Department of Rheumatology and Immunology, Laboratory of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China; West China Lecheng Hospital, Sichuan University, Boao, Hainan, 571435, China.
Best Pract Res Clin Rheumatol. 2025 Mar;39(1):102030. doi: 10.1016/j.berh.2024.102030. Epub 2024 Dec 24.
Rheumatoid arthritis (RA) is a chronic autoimmune disorder with a complex pathogenesis that evolves through various stages before clinical symptoms emerge. This review outlines the natural history of RA, starting from genetic predisposition and environmental triggers to preclinical autoimmunity and subsequent joint inflammation. Key genetic factors interact with environmental elements like smoking and infections, producing autoantibodies such as anti-citrullinated protein antibodies (ACPA) and rheumatoid factor, which precede clinical manifestations by several years. The preclinical phases offer critical opportunities for intervention aiming at halting disease progression. Preventive strategies including lifestyle modifications, dietary interventions, and targeted immune modulation may halt the progression to clinical RA in those at-risk individuals.
类风湿关节炎（RA）是一种慢性自身免疫性疾病，其发病机制复杂，在临床症状出现之前会经历多个阶段。本综述概述了RA的自然史，从遗传易感性和环境触发因素到临床前自身免疫以及随后的关节炎症。关键遗传因素与吸烟和感染等环境因素相互作用，产生抗瓜氨酸化蛋白抗体（ACPA）和类风湿因子等自身抗体，这些自身抗体在临床表现出现前数年就已存在。临床前阶段为旨在阻止疾病进展的干预提供了关键机会。包括生活方式改变、饮食干预和靶向免疫调节在内的预防策略可能会阻止高危个体发展为临床RA。
