title: A new window of opportunity in rheumatoid arthritis: targeting at-risk individuals.
abstract: OBJECTIVE
  Progress in our understanding of the preclinical events in rheumatoid arthritis (RA) has provided important insights into disease pathogenesis. Studying prospective cohorts of individuals at risk for RA development offers the opportunity to accurately characterize the sequence of events in preclinical disease as well as quantify the risk of different preclinical phenotypes. These data may provide the basis for preventive strategies in RA.
  
  
  RESULTS
  RA-related systemic autoimmunity and inflammation occur long before clinical arthritis. There is growing evidence that initiating events may occur at mucosal surfaces including the periodontium, lung and gut and may be influenced by the local microbiome. For potential preventive strategies to be feasible, it is important that individuals at high risk for RA development can be readily identified from the general population. To this end, studying multiple biomarkers in prospective cohorts of at-risk individuals enables risk prediction in different at-risk phenotypes. RA prevention using immunomodulation is currently being investigated in individuals at high risk of RA development.
  
  
  CONCLUSIONS
  The prospective study of at-risk individuals can provide invaluable aetiological insights as well as facilitating accurate risk prediction data. In this way, high-risk individuals may be identified for preventive interventions.
authors.affiliation: aLeeds Institute of Rheumatic and Musculoskeletal MedicinebLeeds Musculoskeletal Biomedical Research Unit, Leeds, UK.
authors.forename: Kulveer
authors.initials: K
authors.lastname: Mankia
authors.forename: Paul
authors.initials: P
authors.lastname: Emery
mesh_terms: D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000276:immunology / Q000628:therapy; D015551:Autoimmunity; D003952:Diagnostic Imaging; D019468:Disease Management; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods*; D013583:Synovial Membrane / Q000276:immunology*