Kevin Deane, MD, PhD, on Preventing Rheumatoid Arthritis

Studies designed to shed light on the prediction of rheumatoid arthritis (RA) are showing substantial promise -- not only for RA but a host of other rheumatic diseases.

Rheumatology care professionals now use biomarkers and other factors such as joint symptoms -- known as pre-RA -- to predict whether an individual who does not have inflammatory arthritis may develop it. The new review, published in Arthritis & Rheumatology, highlighted several clinical trials designed to identify ways to delay or prevent the onset of inflammatory arthritis and RA.

Kevin Deane, MD, PhD, a rheumatologist and researcher at the University of Colorado School of Medicine, served as the review's first author. He recently discussed the study and its findings with MedPage Today. The exchange has been edited for length and clarity.

This paper noted a "paradigm shift" around RA care. What did you mean by that?

Deane: Currently RA is treated once an individual develops joint inflammation. However, based on several factors including our understanding of how RA develops, our ability to predict who may develop RA in the future, and results of ongoing clinical trials, we may soon be identifying individuals who are at risk for future RA before their joints are inflamed. That allows us to intervene earlier to prevent or delay full-blown RA.

This review highlighted several trials underway that are designed to help predict RA. What are some of the most noteworthy things happening in this area of research?

Deane: The key points of this article are that we can now predict with good accuracy who may get RA in the near future. This is largely because the CCP antibody test can detect telltale signs of RA an average of three to five years prior to the onset of joint inflammation.

This test is quite accurate for future RA and has underpinned multiple prevention trials.

Trials now underway are looking at various drugs that are already used in RA treatment and that may also be useful in preventing or delaying full-blown disease if they are given in the pre-RA period. These drugs include hydroxychloroquine, abatacept, methotrexate, and others.

Two of the most intriguing prevention trials currently underway include the Strategy for the Prevention of the Clinically Apparent Onset of RA (StopRA) study in the United States, which focuses on hydroxychloroquine, and the Arthritis Prevention in the Preclinical Phase of RA with Abatacept study in Europe.

The results from these trials could, in the near term, change how we approach RA.

What do you think the future holds for RA care?

Deane: One vision is that, in the near future, RA or pre-RA care would be similar to what is done today with cardiovascular disease. Factors such as high cholesterol and high blood pressure are identified in someone who feels well and as a matter of course are treated to prevent or delay a future heart attack. RA or pre-RA care could someday have that same clarity.

To get there, we will need to find care providers who will help implement prevention, grant agencies to fund preventive research, drug companies that will make drugs and conduct prevention studies, and insurance providers (including governmental) that will support screening and prevention.

Where do you believe more study may be needed on these topics?

Deane: We will need to get buy-in from multiple stakeholders to support prevention. This includes reaching out to individuals who are at risk for RA and enrolling them to participate in prevention research.

In addition, there are many other rheumatic diseases that may also benefit from these prevention efforts, including spondyloarthritis, lupus, gout, and others. We'll need more studies in those areas.

It is exciting that prevention trials in RA are underway and can serve as leaders in changing the paradigm of how we approach rheumatic diseases.

You can read the study here and also expert commentary on the clinical implications here.