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Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease that causes significant health problems as well as high treatment costs. In this issue of Clinical Therapeutics, published by Elsevier, experts are examining many aspects of the detection and intervention of RA, with the general objective of bringing the field closer to the development of effective preventive measures. Identifying people before they develop the disorder could dramatically alter the course of the disease and spare the population its ill effects.
RA affects about 1% of the world's population. It causes swollen and painful joints and can also damage other systems such as skin, eyes, lungs, heart and blood vessels. This debilitating disease results in decreased quality of life, loss of work, pain and suffering. It's also largely an "everlasting" disease whose full-blown RA patients will suffer until the end of their days. Although drugs can control RA in many patients, very few of them experience complete healing and are able to stop treatment. RA is an expensive disease. In the United States, treatment costs about $ 20,000 to $ 30,000 per patient per year.
Kevin D. Deane, MD, Ph.D., Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Colorado Denver, Denver School of Medicine, Denver, Colorado, USA; and Tsang Tommy Cheung, MBBS (HK), Clinical Assistant Professor, Department of Medicine, LKS Faculty of Medicine, Hong Kong University, Hong Kong, this thematic issue draws on the expertise of many scientists from around the world and addresses multiple aspects of RA prevention. "These discussions will hopefully lead to a better understanding of how we can advance RA to the point of preventing the disease and also to indicate how to prevent other autoimmune diseases," explain the guest editors.
Many studies are already underway to learn how to prevent RA. However, the prevention of autoimmune diseases is still a new territory and there is much to discuss and learn. "Most people are well aware of the prevention of diseases such as diabetes, heart disease or cancer," says Dr. Deane. "For example, it is very common for a person to have routine blood tests, which can reveal high cholesterol, a potential risk factor for a heart attack, so that the person can change their lifestyle by modifying their blood pressure. lifestyle, including adopting a healthier diet, quitting smoking and doing more exercise, or taking a medication to reduce the risk of future heart attack.We have developed these approaches for the prevention of heart attack through clinical trials The community of people with RA has learned from these approaches and similar prevention-type trials are underway in PR. "
"Most autoimmune diseases are only identified when an individual is" sick. "For example, with RA, once one has painful and swollen joints," adds Dr. Cheung. Blood tests can now identify people at risk before feeling ill, opening up a whole new world of screening and prevention. Treating RA very early may allow cheaper and safer treatments to work because a full-fledged PR has developed, usually very potent drugs are needed to control the disease. "
In a commentary on the clinical burden of RA, John M. Davis III, MD, MS, badociate professor of medicine, division of rheumatology at the Mayo Clinic College of Medicine and Science, Rochester, MN, USA, argues that approaches Preventive measures greatly benefit patients with RA. "There has been great progress in the development of synthetic, biologic, and targeted disease modifying (DMARD) antirheumatic drugs (DMARDs) to treat RA, as well as strategies for using these agents to control the disease." inflammation badociated with the disease at a low activity level of the disease or clinical remission, "he says. "However, with a given treatment strategy, up to 40-60% of patients ultimately respond inadequately.Investment in the development of preventive strategies should ultimately lead to a paradigm shift in the treatment of disease and its complications in maintaining the health of people around the world. "
Articles in this thematic issue subject to rigorous peer review deal with topics such as the natural history of RA; nomenclature for the stages of development of RA; potential pharmacological targets; prevention potential by targeting mucosal processes; predict RA in people at risk; optimal trial design for RA prevention studies; the patient's preferences; regulatory considerations; the challenges of the system; security monitoring; and adverse events. All authors contributed significantly to the overall development of RA prevention.
The question identifies several important challenges:
- Ensure that the company invests in prevention, which requires that groups such as governments, the insurance industry and pharmaceutical companies also be interested in prevention and be willing to support it.
- Find workable prevention approaches – be they drugs or lifestyle changes (for example, smoking cessation), or a combination of both.
- Find people at risk for future RA through simple methods, such as population-based blood tests or other approaches.
- Bring research and the medical community to agree on the right terminology for RA. "At the moment, PR is only applied when a person is suffering from arthritis. However, we may need to develop new terms, such as" Pre-PR. " that can be used to identify a person at high risk of future RA Diabetes is commonly used and helps people understand that they are at a stage of illness that indicates that they may become worse if they do not do not do anything, we need similar terms in PR that can reach people and help them get into action, "said Dr. Deane.
- The patient's preference is also a major challenge. "Asking people at risk to take medications with possible side effects when there is no clinically apparent disease is not easy at all," Dr. Cheung observes.
Many other rheumatic and autoimmune diseases follow a pattern similar to that of RA, where there are abnormal blood markers, sometimes years before the person feels "sick" from the disease. Lupus, gout and other diseases such as vasculitis.
The science of RA is in a happy situation compared to many other inflammatory diseases, where it is seldom unclear when and where specific immunity to disease can be triggered and how it can progressively evolve towards targeting. Final organ. The research and solutions proposed in this issue may also serve as an example of many other chronic immune-mediated diseases. "
Lars Klareskog, MD, PhD, Rheumatology Unit, Department of Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden, in a guest editorial
Editor-in-Chief Richard Shader, MD, Tufts University School of Medicine, Boston, MA, USA
The efforts of this team of experts to raise awareness of RA and to explore early detection and intervention methods should encourage medical and scientific communities to intensify their efforts to find better ways of treating and perhaps even to prevent RA and its complications. "
Previous research has already shown that the development of RA can be delayed with a single dose of medication commonly used in people with complete RA. This discovery suggests that if individuals can be identified at the right time, a future PR can be delayed or completely avoided. Several ongoing clinical trials should also help determine which drugs can prevent RA and which are the best candidates to receive this treatment.
"Treating RA very early can lead to cheaper and safer treatments, because once PR is developed, very powerful medications are usually needed to control the disease – it's like setting a fire on fire. is still at the candle stage it's quite difficult.However, it's very difficult to stop a fire when a full-blown forest fire develops. "conclude the guest editors.
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