'Window of opportunity' for rheumatoid arthritis prevention remains elusive
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For the prevention of rheumatoid arthritis to become feasible, it may be necessary to intervene as soon as possible in the pre-RA course, although the specific timing remains unclear, according to a speaker at the EULAR 2023 Congress.
“We talked about prevention, and my conclusion was ‘maybe,’” Daniel Aletaha, MD, of the Medical University of Vienna, told attendees. “Maybe, if we go very early and maybe if we use abatacept (Orencia, Bristol Myers Squibb) or comparable modes of action that are interfering with the immune system rather than blocking cytokines or inflammation.”
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Prevention is one of the next logical places for researchers and clinicians to look to find the next wave of innovation in RA, due to much of the work being done in the pre-RA space.
“If you look at innovation in rheumatoid arthritis, a lot of it is about pre-RA and how we can interfere with the disease process and maybe change the disease itself,” Aletaha said. “The timepoint where we can do that remains unclear.”
If efforts to prevent RA are undertaken in earnest, it will require researchers and clinicians to consider disease manifestations that show up early in the disease course.
“If you think about preventing RA, we need to move a bit earlier than that,” Aletaha said, remarking that intervention should begin as early as is feasible if prevention is the goal.
In the pre-RA stage, there are many in-motion processes regarding immunological systems in patients, he added.
“The idea is, if we do preventive therapies, not to be required to treat these patients permanently, but rather to change their disease course,” Aletaha said.
Knowing the correct time to implement interventions may allow for the opportunity to change the way RA is managed. To shed light on the optimal timing to try to induce these changes, scientists should be looking at various patient populations and treatment targets, according to Aletaha.
“We have many different options to investigate pre-RA,” he said. "You can start with patients who have clinical symptoms, clinical arthritis, you can start with patients who do not have arthritis clinically, but they have subclinical arthritis symptoms.”
In addition, it may be worth considering patients who have symptoms, but do not yet exhibit definitive signs of subclinical arthritis, Aletaha said.
Another group worth looking into would be patients who do not have any disease manifestations, but are at risk for developing RA, he added.
“The conclusion is difficult,” Aletaha said. “I think the window of opportunity question is still not resolved, and it might be necessary to go to really early pre-RA patients, before clinical manifestations are classifiable.”
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Aletaha D. What is new: Rheumatoid arthritis. Presented at: EULAR 2023 Congress; May 31 to June 3, 2023, Milan, Italy.
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