Abstract
BackgroundThe accumulation of risk for the development of rheumatoid arthritis (RA) is regarded as a continuum that may start with interacting environmental and genetic factors, proceed with the initiation of autoimmunity, and result in the formation of autoantibodies such as anti-citrullinated peptide antibodies (ACPA). In parallel, at-risk individuals may be asymptomatic or experience joint pain (arthralgia) that is itself non-specific or clinically suspicious for evolving RA, even in the absence of overt arthritis. Optimal strategies for the management of people at-risk of RA, both for symptom control and to delay or prevent progression to classifiable disease, remain poorly understood.MethodsTo help address this, groups of stakeholders from academia, clinical rheumatology, industry and patient research partners have collaborated to advance understanding, define and study different phases of the at-risk state. In this current report we describe different European initiatives in the field and the successful effort to build a European Registry of at-risk people to facilitate observational and interventional research.ResultsWe outline similarities and differences between cohorts of at-risk individuals at institutions spanning several countries, and how to best combine them within the new database. Over the past 2 years, besides building the technical infrastructure, we have agreed on a core set of variables that all partners should strive to collect for harmonization purposes.ConclusionWe emphasize to address this process from different angles and touch on the biologic, epidemiologic, analytic, and regulatory aspects of collaborative studies within a meta-database of people at-risk of RA.
Highlights
The current classification criteria for rheumatoid arthritis [1, 2] published in 2010 make it possible to better define patients at an earlier stage of their disease course in comparison to 1987 ACR criteria
Further insights into the development of rheumatoid arthritis (RA) have been formalized into an agreed concept that constitutes the basis for the definition of the criteria of clinically suspect arthralgia (CSA) amongst individuals at risk to develop RA [6]
We describe and compare cohorts of five RTCure partners (Karolinska Institutet, Medical University of Vienna, University Clinic Erlangen, Leiden University Medical Center and University of Newcastle)
Summary
The current classification criteria for rheumatoid arthritis [1, 2] published in 2010 make it possible to better define patients at an earlier stage of their disease course in comparison to 1987 ACR criteria. In some individuals certain environmental and/or genetic risk factors can lead to the awakening of systemic autoimmunity, the formation of autoantibodies and musculoskeletal (MSK) symptoms, before the onset of arthritis [7–11]. Patients that eventually develop clinically apparent arthritis might be classified at some point as having RA. Based on this concept (Figure 1), it is of importance for further understanding of the gradual emergence of RA and for the development of preventive strategies for arthritis that cohorts of individuals with musculoskeletal symptoms and RA-associated immunity are created. Optimal strategies for the management of people at-risk of RA, both for symptom control and to delay or prevent progression to classifiable disease, remain poorly understood
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