Rheumatoid arthritis (RA) is known to include a 'pre-RA' stage that can be defined as the presence of familial or genetic risk factors, biomarker abnormalities (e.g. autoantibodies to citrullinated peptide antigens [ACPA]), symptoms and even abnormal imaging findings prior to the development of the onset of 'clinical RA' with inflammatory arthritis that is apparent on physical examination. Indeed, there are multiple completed or ongoing retrospective case-control as well as prospective observational studies to identify the key biologic drivers of disease. Furthermore, building on the predictive ability of combinations of biomarkers, symptoms and imaging for future RA, there are multiple clinical trials completed, underway or in development to identify approaches that may prevent, delay or ameliorate future clinical RA in at-risk individuals. Importantly, however, while an effective preventive intervention has not yet been identified, at-risk individuals are being increasingly identified in clinical care; and this presents a challenge of how to manage these individuals in clinical practice. This review will discuss the current understanding of the biology and natural history of RA development, nomenclature and current models for prediction of future RA, as well as evaluate the current and ongoing clinical prevention trials with the overall goal to provide insights into the challenges and opportunities in the field of RA prevention. Moreover, this review will provide up-to-date options for clinical management of individuals at-risk for RA.

中文翻译：

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类风湿性关节炎：疾病的连续体以及预测、早期干预和预防的策略。

已知类风湿性关节炎 (RA) 包括“RA 前期”阶段，该阶段可定义为存在家族或遗传危险因素、生物标志物异常（例如瓜氨酸肽抗原 [ACPA] 的自身抗体）、症状甚至异常影像学结果在出现“临床 RA”（伴有炎症性关节炎）之前，这种情况在体格检查中很明显。事实上，有多项已完成或正在进行的回顾性病例对照以及前瞻性观察研究来确定疾病的关键生物学驱动因素。此外，基于生物标志物、症状和影像学组合对未来 RA 的预测能力，已经完成、正在进行或正在开发多项临床试验，以确定可以预防、延迟或改善高危个体未来临床 RA 的方法。然而，重要的是，虽然尚未确定有效的预防干预措施，但在临床护理中越来越多地识别出高危人群；这对如何在临床实践中管理这些人提出了挑战。本综述将讨论当前对 RA 发展的生物学和自然史的理解、命名法和当前预测未来 RA 的模型，并评估当前和正在进行的临床预防试验，总体目标是提供对挑战和机遇的见解在RA预防领域。此外，本次审查将为有 RA 风险的个体的临床管理提供最新的选择。