Rob Volansky , 2025-05-06 09:30:00
DESTIN, Fla. — Rheumatoid arthritis prevention in patients at the subclinical or pre-clinical stage remains challenging, according to a speaker at the Congress of Clinical Rheumatology East annual meeting.
“You will see individuals in your clinic who will be in pre-RA or in the at-risk stage of disease and this will give you some ideas for management of them,” Kevin D. Deane, MD, PhD, William P. Arend endowed chair for rheumatology research at the University of Colorado Anschutz Medical Campus, and director of the University of Colorado Autoimmune Disease Prevention Center, told attendees.
“There is no currently FDA approved pharmacotherapy for rheumatoid arthritis prevention,” Kevin Dean, MD, PhD, told attendees. Image: Rob Volansky | Healio
Deane’s presentation largely focused on patients who were positive for anti-cyclic citrullinated peptide (CCP) or anti-citrullinated protein antibodies (ACPA). The first consideration, according to Deane, pertains to how to categorize and address these patients.
“‘At risk’ is so vague,” Deane said. “‘Pre-RA’ or ‘pre-clinical’ may also be incorrect, depending on whether the patient ultimately develops RA or not. The nomenclature is controversial.”
The controversy is not limited to clinicians and researchers hoping to define the terms. Telling a patient they have a swollen joint or synovitis, even if it does not ultimately evolve into RA, can be significant.
“Individuals who are at risk for RA can get a little bit weird about it,” Deane said. “They have a new relationship with these new symptoms. They may be in denial once they have a swollen joint, and they may not come see us. It’s tricky.”
Education is critical in these cases, according to Deane.
“I give fairly extensive education about what RA is and what symptoms are,” he said.
Education can also feature information about lifestyle factors.
“We ask people to stop smoking things if they can do it,” Deane said.
Exercise, a healthy diet and periodontal health are also recommended.
“You may have heard that periodontal disease is a risk factor for future RA,” Deane said. “At best, it’s controversial.”
He later suggested that improved periodontal health is likely beneficial for the patient’s health regardless of whether it can prevent RA or not.
Another concern for pre-RA management is the dearth of options for these patients, according to Deane.
“There is no currently FDA approved pharmacotherapy for RA prevention,” he said.
In the absence of medications, Deane offered some pointers for approaching patients in this ambiguous territory. The first step, he said, is to conduct a thorough physical exam.
“The gold standard for diagnosing rheumatoid arthritis is still a physical exam,” he said.
Imaging can help detect synovitis, but challenges remain for this approach, as well, according to Deane.
“We may get to the point where MRI or ultrasound is the gold standard, but we are not there yet,” he said.
Moreover, even if subclinical synovitis is detected on imaging, it does not necessarily mean that the patient will progress to RA or have persistent disease or symptoms.
Regardless of what the period before RA development is called and how the symptoms are assessed and diagnosed, Deane stressed that early intervention is critical.
“If you catch someone within weeks or months of the first swollen joint, they do much better than if you catch them after years,” he said. “Let’s not wait for people to get sick.”
Sources/Disclosures
Collapse
Deane K. Therapeutic Intervention in RA: When and Which Drug? Is It Possible to Prevent Clinically Impactful Disease? Presented at The Congress of Clinical Rheumatology East; May 1-4, 2025; Destin, Florida (hybrid meeting).
Disclosures:
Deane reports receiving grant funding from Boehringer Ingelheim, Gilead and ThermoFisher, and consulting for Bristol Myers Squibb, ThermoFisher and Werfen/Inova Diagnostics.
