Abstract
Currently, there is an increasing interest in treating patients at risk of rheumatoid arthritis (RA) to prevent the development of this chronic disease. In this sense, research has focused attention on the early identification of predictive factors of this disease. Autoantibodies and markers of systemic inflammation can be present before clinical arthritis and RA development. So, the phase of inflammatory arthralgia preceding clinical arthritis is an important part of the window of opportunity and, starting treatment might prevent progression to chronic arthritis. Additionally, the early diagnosis and treatment initiation, in patients with inflammatory arthritis at risk of persistence and/or erosive progression, are fundamental because may allow optimal clinical responses, better chances of achieving sustained remission, preventing irreversible organ damage and optimizing long-term outcomes. This review aims to give an overview of clinical risk factors for developing RA, both in suspected arthralgia and in undifferentiated arthritis. Besides taking into consideration the role of serological markers (immunological and acute phase reactants) and clinical features assessed at consultation such as: articular affection and patient's clinical perception. Other features as sociodemographic and environmental factors (lifestyle habits, microbiota, periodontal disease among others), have been included in this revision to give an insight on strategies to prevent development of RA and/or to treat it in early stages.
Highlights
Rheumatoid arthritis (RA) is a chronic inflammatory joint disease characterized by chronic synovitis, joint destruction and disability [1]
It is known that the pre-clinical phase of RA development can last for years, which has led in recent years to a renewed determination to identify those patients at high risk of developing persistent joint disease, which can lead to irreversible joint damage [2]
We focused on risk factors for the onset of RA in susceptible patients (CSA or undifferentiated arthritis (UA)) and evaluated modifiable factors that can affect disease development
Summary
Rheumatoid arthritis (RA) is a chronic inflammatory joint disease characterized by chronic synovitis, joint destruction and disability [1]. It is known that the pre-clinical phase of RA development can last for years, which has led in recent years to a renewed determination to identify those patients at high risk of developing persistent joint disease, which can lead to irreversible joint damage [2]. While signs or symptoms can initially be absent, autoimmunity can still exist [3]. During this early phase, arthralgia without clinical synovitis may be present, or patients may develop inflammatory arthritis without fulfilling any of the classifiable forms of arthritis [2].
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