RA Prevention: Introduction
Healthcare now is moving towards prevention, or at the very least very early detection, as a means to manage many of the diseases that affect the population. For example, vaccines are given against a wide variety of pathogens in order to prevent morbidity and mortality from infections. Also, individuals are screened for risk factors for cardiovascular disease (CVD), and once identified, risk factors that can be modified are addressed to help prevent or delay CVD events. Importantly, the ability to prevent diseases such as infections and CVD comes from substantial research that was performed in order to understand the natural history of disease, and important etiologic factors. Once the natural history of disease was sufficiently understood, studies then demonstrated the benefit of screening for risk factors as well as the benefit of interventions to improve disease outcomes. For example, in CVD large-scale prospective studies identified risk factors for disease such as hypertension, diabetes, and smoking, and based on these risk factors, instruments such as the Framingham score were developed to accurately predict an individual patients risk for a CVD event within a defined time period. Once identified, specific risk factors can be modified to reduce the risk for CVD events.
However, while many diseases have in-place preventive or early identification approaches, other diseases that have a substantial impact on public health are still typically managed by treating patients once the signs and symptoms of disease have developed. In particular, rheumatoid arthritis (RA) is an autoimmune disease that affects approximately 1% of the population, leading to substantial adverse effects on public health, with recent studies suggesting that the overall costs of this disease exceed $30 billion annually in the United States. There are multiple treatments now available for RA, but even with early identification and treatment of RA, this disease still results in substantial morbidity and increased mortality. However, what if we could approach diseases like RA, or other rheumatic autoimmune diseases that have a similar overall model of development, like we do CVD, in which individuals are identified prior to the onset of clinically apparent disease? Could interventions then be applied to prevent adverse outcomes from developing?
Fortunately, for patients suffering from RA, research has led us to the point where we may be able to prevent this disease in the near future. Herein I will discuss what is known about the natural history of RA development, and how this knowledge may be applied to screening, and eventually preventive strategies addressing the disease.