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Striking a balance in rheumatoid arthritis prevention trials

The discovery that autoantibodies and other factors can predict the future onset of rheumatoid arthritis (RA) has encouraged the development of clinical trials looking at RA prevention. Although an exciting area of research, finding an approach that results in the successful completion of an RA prevention trial is challenging.

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Fig. 1: Balancing factors related to study design and participation in RA prevention trials.


  1. 1.

    Deane, K. D. & Holers, V. M. Rheumatoid arthritis pathogenesis, prediction, and prevention: an emerging paradigm shift. Arthritis Rheumatol. 73, 181–193 (2021).

    Article  Google Scholar 

  2. 2.

    van Boheemen, L. et al. Atorvastatin is unlikely to prevent rheumatoid arthritis in high risk individuals: results from the prematurely stopped STAtins to Prevent Rheumatoid Arthritis (STAPRA) trial. RMD Open 7, e001591 (2021).

    Article  Google Scholar 

  3. 3.

    van Boheemen, L. et al. How to enhance recruitment of individuals at risk of rheumatoid arthritis into trials aimed at prevention: understanding the barriers and facilitators. RMD Open 7, e001592 (2021).

    Article  Google Scholar 

  4. 4.

    Al-Laith, M. et al. Arthritis prevention in the pre-clinical phase of RA with abatacept (the APIPPRA study): a multi-centre, randomised, double-blind, parallel-group, placebo-controlled clinical trial protocol. Trials 20, 429 (2019).

    Article  Google Scholar 

  5. 5.

    Gerlag, D. M. et al. Effects of B-cell directed therapy on the preclinical stage of rheumatoid arthritis: the PRAIRI study. Ann. Rheum. Dis. 78, 179–185 (2019).

    CAS  Article  Google Scholar 

  6. 6.

    Holers, V. M. et al. Rheumatoid arthritis and the mucosal origins hypothesis: protection turns to destruction. Nat. Rev. Rheumatol. 14, 542–557 (2018).

    Article  Google Scholar 

  7. 7.

    Falahee, M. et al. Preferences of patients and at-risk individuals for preventive approaches to rheumatoid arthritis. Clin. Ther. 41, 1346–1354 (2019).

    Article  Google Scholar 

  8. 8.

    Tanner, S. et al. A prospective study of the development of inflammatory arthritis in the family members of Indigenous North American people with rheumatoid arthritis. Arthritis Rheumatol. 71, 1494–1503 (2019).

    CAS  Article  Google Scholar 

  9. 9.

    Ellerby, J. H. et al. Bioethics for clinicians: 18. Aboriginal cultures. CMAJ 163, 845–850 (2000).

    CAS  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Gerlag, D. M. et al. EULAR recommendations for terminology and research in individuals at risk of rheumatoid arthritis: report from the Study Group for Risk Factors for Rheumatoid Arthritis. Ann. Rheum. Dis. 71, 638–641 (2012).

    Article  Google Scholar 

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Correspondence to Kevin D. Deane.

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O’Neil, L.J., Deane, K.D. Striking a balance in rheumatoid arthritis prevention trials. Nat Rev Rheumatol (2021).

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