Prevention of rheumatic diseases: strategies, caveats, and future directions

Abstract

Rheumatic diseases affect a significant portion of the population and lead to increased health care costs, disability, and premature mortality; effective preventive measures for these diseases could lead to substantial improvements in public health. Natural history studies show that for most rheumatic diseases there is a period of preclinical disease development during which abnormal biomarkers or other processes can be detected. These changes are useful to understand mechanisms of disease pathogenesis; in addition, they may be applied to estimate a personal risk of future disease while individuals are still relatively asymptomatic and ultimately be used to identify individuals who may be targeted for preventive interventions.

Keywords: Prediction; Prevention; Rheumatic diseases.

Figure 1. Natural history of rheumatic disease and possibilities for prevention

This figure illustrates the natural history of rheumatic disease beginning on the left with no disease, although genetic and environmental factors may be present. Over time, there is early evidence of disease that is not clinically apparent. Examples of this are autoantibodies, elevated uric acid, or early cartilage injury. Later, clinically apparent disease develops that may be classifiable as a specific rheumatic disease. Once disease is clinically manifest, longer-term outcomes include issues such as response to therapy, disability. Throughout disease evolution, there are ongoing influences from genetic and environmental factors. Progression of rheumatic disease may be prevented at several points: prior to development of asymptomatic disease (primary prevention), during asymptomatic disease (secondary prevention), and after clinically-apparent disease has developed (tertiary prevention).

Figure 2. Theoretical 5-year risk of developing rheumatoid arthritis above which persons at risk are willing to take preventive medicine

At a 30% hypothetical risk of developing RA within the next 5 years, the majority of first degree relatives of patients with RA were willing to take a limited preventive treatment. Adapted from Novotny F, Haeny S, Hudelson P, Escher M, Finckh A. Primary prevention of rheumatoid arthritis: A qualitative study in a high-risk population. Joint Bone Spine. 2013;80(6):673-4. doi: 10.1016/j.jbspin.2013.05.005. PubMed PMID: 23835304; with permission.