Advances in understanding preclinical rheumatoid arthritis and prospects for prevention

New research published in 2025 sheds light on the pre-clinical period that precedes the onset of classifiable rheumatoid arthritis, from risk factors to immunological events and opportunities to prevent the transition to clinical disease.

Key advances

• Dietary polyunsaturated fatty acids, in particular omega-3 fatty acids, reduce the risk of rheumatoid arthritis (RA) development in genetically susceptible people at least in part through their effects on immune pathways¹.

• Naive T cell and B cell subsets are probably in a functionally primed state prior to antigen exposure, and transcriptional changes in activated CD4⁺ memory T cells with a B cell helper gene signature are seen in people at risk of RA who progress to RA².

• Clinically relevant, data-driven guidelines for risk stratification in people at risk of RA with arthralgia, using clinically feasible measures, can effectively predict which groups will progress to clinical disease and thus are most likely to benefit from pre-disease interventions³.

• Hydroxychloroquine taken for 1 year does not prevent anti-citrullinated protein antibody (ACPA)-positive people from developing RA⁴.