Can rheumatoid arthritis be prevented? | Explained

Can doctors prevent rheumatoid arthritis from developing in people who don't yet have it? | Photo by Getty Images/iStockphoto

Story so far: Early this week, lancet We have published the results of a study that proposes repurposing existing drugs to treat rheumatoid arthritis to prevent the disease. Can doctors prevent rheumatoid arthritis from developing in people who haven't yet developed it (for which there are biomarkers to help)? “By targeting the adaptive immunity of these individuals at an early stage, we can prevent the development of rheumatoid arthritis.”

What is rheumatoid arthritis?

This is a chronic autoimmune disease that primarily affects the joints. Scientists still do not understand why autoimmune conditions occur and cause the body's protective immune system to attack itself. Patients experience loss of function and mobility as a result of pain, joint swelling, and stiffness. As expected, this can significantly reduce the patient's quality of life. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health, rheumatoid arthritis affects the lining of joints and damages the tissue lining the ends of the bones in the joints. Often occurs in a symmetrical pattern. This means that when this condition occurs in one knee or hand, the other hand or knee is often affected as well. Fatigue, occasional fever, and loss of appetite are to be expected, and it can cause diseases not only affecting the joints but also the heart, lungs, blood and nerves, eyes, and skin.

What was this study trying to do?

In a paper by Andrew P. Cope et al. He explains that the purpose was to evaluate gender.

This drug is a “co-stimulatory modulator” that acts as a signaling pathway to initiate an appropriate immune response.

The core of their experiment is to detect autoantibodies associated with rheumatoid arthritis, known as anti-citrullinated peptide antibodies (ACPAs), to identify individuals at high risk for rheumatoid arthritis as early as years before they actually develop the disease. The understanding is that it can be identified several decades ago. , in the blood.

Although the presence of autoantibodies may be present for more than 10 years before the onset of the disease, the combination of ACPA, symptoms, and imaging evidence of subclinical synovitis (inflammation of the joint lining) suggests that autoantibodies may be present in most severe cases. The predictive power to identify an individual has increased. There is a high possibility that it will progress to rheumatoid arthritis within 2 years. These characteristics provided a framework for evaluating treatment strategies that could delay or prevent the onset of the disease, the authors said.

These results demonstrate that a rheumatoid arthritis prevention trial is feasible and that the existing rheumatoid arthritis drug abatacept could be used to target adaptive immunity at an early stage, before clinically evident arthritis becomes apparent. It has been shown that it can prevent the onset of rheumatoid arthritis. The drug of choice is abatacept, a biological disease-modifying antirheumatic drug that works by selectively modulating signals to promote T-cell activation and initiate the body's immune response. To do.

What is the scenario in India regarding rheumatoid arthritis treatment?

“This is a story that has been going on for years: How can we slow down the progression of rheumatoid arthritis?” says Rohini Handa, a renowned rheumatologist at Apollo Indraprastha Hospital. Abatacept, a drug classified as a 'biological drug', is no longer available in India, he points out. It was withdrawn because it did not sell well in the Indian market. But in the past five years, six of his rheumatoid arthritis treatments have appeared. Currently, there are 10 biologics available around the world, of which 6 are available in India. About three years ago, a series of drugs called JAK inhibitors went off-patent, and one of them, tofacitinib, is available for ₹900 for a month's supply. It's also an oral medication, he says, as opposed to biologics, which are injected intravenously or subcutaneously, depending on which part of the world you live in. “Biologically, there is no equivalent.”

Is early prevention of disease important?

So far, treatment depends on being able to start early, explains Dr. Handa. “Such preventive measures are intuitively appealing if someone has a family history. Autoantibodies appear years before symptoms appear. If you can, that's definitely a big draw.'' However, there are some gray areas in using such prevention methods. “To use a drug for something that's going to happen in 20 years, you have to convince people who have blood abnormalities but no physical abnormalities to start treatment. So what's the end point of this? “When do you stop treatment?” Dr. Handa asks. Research supports this concern.

Also read | “Rheumatoid arthritis also affects other parts of the body.”

Premorbid treatment with abatacept reduces progression to clinically evident arthritis during the 12-month treatment period and for up to 24 months after treatment discontinuation. However, by 24 months, the parameters of those receiving the drug were similar to those of the placebo group. This was similar between groups, indicating that treatment was not sustained. “We take a common sense approach. We tell all of our patients that smoking is a strong risk factor and encourage them to stop smoking, exercise and eat a healthy diet.” can be implemented at scale, so we need to make sure this message gets across,” says Dr. Handa.