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Rheumatologists and physicians are commonly asked, "what can I do to avoid rheumatoid arthritis?" This is usually a concern for family members of those affected by RA.
However, the answers to this question aren't so clear. Few patients will inherit RA from a parent or family member. Even monozygotic twins will have less than 20% chance of both developing RA, if one has RA.
The world's top researchers of the pathogenesis of rheumatoid inflammation (Drs. Klareskog and Holers - along with Dr. Razza) have published a prologue to a series of articles appearing in Rheumatology that will address if we can predict and prevent RA. Specifically, this series will discuss genetic risk factors, the interaction genetic factors and environmental exposures, strategies to predict RA development in at-risk populations, and strategies to prevent RA in those at risk.
They discuss the 5 phases that lead to the development of clinically manifest RA - Genetic/At-Risk, Environmental exposure, Autoimmune, Early inflammatory, Polyarthritis with established disease. These have led to important investigations in "at-risk" individuals and will soon study if interventions in such people can help to avoid RA onset.
Numerous challenges remain, including: 1) the identification of requisite "triggers", 2) the role of cigarette smoke, toxins, and the microbiota, 3) what is unique and important in those who are seronegative, and 4) are there other disease models we can learn from.
The first article in this series by Karlson et al examines strategies to predict RA onset in at-risk individuals.