Painful, swollen joints are the calling card of rheumatoid arthritis (RA), which afflicts nearly 1.3 million Americans. This disease develops when the immune system mistakenly targets and damages the linings of joints. Long before the classic symptoms of joint pain and swelling develop, it seems likely that early symptoms occur, which are often overlooked.
A condition called preclinical rheumatoid arthritis occurs when there is no joint inflammation, yet a person’s blood test shows certain biomarkers, including:
- Rheumatoid factor
- Anticyclic citrullinated peptide (CCP) antibodies
- Antibodies to citrullinated protein antigens
People with preclinical rheumatoid arthritis are more likely to be female, older, and have a first-degree relative with RA. Preclinical RA can be associated with mild joint discomfort or minor swelling, in addition to one or more of the blood biomarkers. These biomarkers generally appear 3-5 years prior to classic rheumatoid arthritis symptoms.
There may be clinical interventions that can prevent or delay RA onset in those with preclinical RA. A new analysis of interventions concluded that very early intervention with disease-modifying antirheumatic drugs (DMARDs) can significantly reduce the risk of RA onset. What this means is starting RA medications at earlier stages than has previously been standard could bring long-term health benefits.
This new approach to preclinical RA is not yet standard practice. In the meantime, anyone with preclinical RA would be wise to make changes in their life. These are modifiable risk factors that affect RA risk, particularly in anyone with preclinical RA. To minimize the progression to RA the best advice is to:
- Stop smoking
- Exercise regularly
- Lose excess weight (especially to avoid being in the obese category)
Hilliquin S, Hugues B, Mitrovic S, et al. Ability of disease-modifying antirheumatic drugs to prevent or delay rheumatoid arthritis onset: a systematic literature review and meta-analysis. Ann Rheum Dis 2018;77(8):http://dx.doi.org/10.1136/annrheumdis-2017-212612.