Perspectives of at-Risk Individuals on Preventive Intervention for Rheumatoid Arthritis: A Mini Review

Abstract

There has been intense research focus on the biological mechanisms underlying the transition from health to disease for rheumatoid arthritis (RA) over recent years, and it is now well established that a state of autoimmunity precedes the development of symptoms for a large proportion of patients. This has led to an increased interest in the identification of at-risk groups and the potential for preventive intervention. The ability of several immunomodulatory agents to delay or prevent RA is under investigation and novel cellular therapies are in development. Preventive approaches are also being assessed in other chronic autoimmune diseases. For example, an anti-CD3 antibody has recently been shown to delay progression to type 1 diabetes in non-diabetic relatives of patients identified as being at high risk. The identification and treatment of individuals as being at risk of a disease where there is a degree of uncertainty around the potential for benefit is socially and ethically challenging. Recently reported difficulties in recruitment to RA prevention trials have underlined the importance of understanding the perspectives of at-risk individuals to identify barriers and facilitators that need to be addressed in order for preventive strategies to be acceptable. Understanding of their preferences for benefits and risks of preventive interventions can inform efficient intervention prioritization, prevention trial design and the development of informational resources for those at risk. In this review we summarize current knowledge of preferences for RA prevention and make recommendations for further research needed to ensure efficient development of preventive therapies and clinical implementation.

Integrated single cell and spatial transcriptomics reveal autoreactive differentiated B cells in joints of early rheumatoid arthritis

“…Future studies will show if this new ACPA also has functional capacities. Plasma cell survival niches in the joint were found present already at time of RA diagnosis supporting the notion that such structures are attractive therapeutic targets in RA 45 or even individuals at risk of developing RA 46 , 47 .…”

Acceptable risks of treatments to prevent rheumatoid arthritis among first-degree relatives: demographic and psychological predictors of risk tolerance

“…14 15 While preventive interventions for RA could reduce patient burden and societal cost at scale, few studies have quantified the preferences of at-risk groups for risks and benefits of treatments to reduce the chance of developing RA. Previous qualitative studies have found that the acceptability of preventive approaches for RA is influenced by perceptions of treatment effectiveness and harms, 16 but there are limited examples of studies to quantify the relative importance of treatment attributes, benefit-risk trade-offs and preference heterogeneity. 17 One study eliciting preferences for preventive treatments for RA which used profile-case best-worst scaling 18 had a relatively small sample size and did not report acceptable benefit-risk trade-offs.…”

Editorial: Autoimmune pre-disease

“…In SLE, rheumatoid arthritis and type 1 diabetes (T1DM) the presence of disease-specific autoantibodies prior to clinical disease manifestation is well-established (6)(7)(8)(9)(10). This is less well characterized for autoantibodies targeting BP180 or BP230, which characterize and cause bullous pemphigoid (14).…”