Page 64 - THE EVOLUTION OF EARLY ARTHRITIS AND CARDIOVASCULAR RISK Samina A. Turk
P. 64

CHAPTER 3
SUMMARY
The increasingly successful management of RA now leads to more patients achieving early and sustained remission, and this will lead to less patients progressing to the classical state of established RA. A next goal in the management of RA can be the improved recognition and intervention in the early or even at-risk phase of RA.
Prediction depends on the knowledge of risk factors. Recent advances in the risk factor assessment of RA include alcohol consumption as a confirmed protective factor, whereas fish consumption could not be confirmed as a protective factor. New risk factors are coffee consumption, sugar consumption, sleep disorders, and thyroid disease, whereas exercise and recent infections have been put forward as protective factors. Increasingly, risk factors are being combined to establish prediction rules. Those containing genetic risk plus environmental factors are not yet ready for general use. However, new prediction rules for arthralgia subjects using clinical characteristics, serology, and sometimes imaging are quite simple to perform, and they can be used to inform patients of their risk of RA.
Interestingly, RA incidence seems to have been declining since 1955, when formal measurements started, at least until the end of the last century. However, recent reports suggest that the incidence is on the rise again, mainly in seronegative females, and that this can be ascribed largely to the recent increase in obesity. When comparing trends in different countries, it becomes necessary to take into account the large variation between countries in the public and physician awareness of the need to identify RA early.
The problem of assessing UA has been reduced considerably by the introduction of the 2010 RA criteria. Many former UA patients can now be classified as RA, leaving a smaller group of UA patients with more heterogeneous and milder disease. Treating UA patients early gives results similar to early treatment of RA. In line with the concept of an early “window of opportunity,” a few studies have attempted to treat patients at an even earlier stage, before clinical arthritis becomes apparent. These primary prevention studies with pharmacological interventions have not yet produced positive results. Although these efforts are continued, the identification of modifiable risk factors for RA such as smoking, obesity, and lack of exercise should incite physicians to promote healthy behavior in persons at risk of RA.
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