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Rheum Dis Clin North Am [journal]
- Preclinical rheumatic disease. [Editorial]
- Rheum Dis Clin North Am 2014 Nov; 40(4):xv-xviii.
- Foreword. [Editorial]
- Rheum Dis Clin North Am 2014 Nov; 40(4):xiii.
- Lessons from Type 1 Diabetes for Understanding Natural History and Prevention of Autoimmune Disease. [REVIEW]
- Rheum Dis Clin North Am 2014 Nov; 40(4):797-811.
Type 1 diabetes (T1D) is a chronic autoimmune disorder resulting from immune-mediated destruction of insulin-producing beta cells within the pancreatic islets. Prediction of T1D is now possible, as having 2 or more islet autoantibodies confers a 100% risk of diabetes development. With the ability to predict disease development, clinical trials to prevent diabetes onset have been completed and are currently under way. This review focuses on the natural history, prediction, and prevention trials in T1D. We review the lessons learned from these attempts at preventing a chronic autoimmune disease and apply the paradigm from T1D prevention to other autoimmune disorders.
- Developing Evidence-Based Screening Recommendations, with Consideration for Rheumatology. [REVIEW]
- Rheum Dis Clin North Am 2014 Nov; 40(4):787-795.
Screening for presymptomatic disease provides the potential for early intervention and improved outcomes. However, although this practice has potential benefits, it also has potential harms that must be considered. The U.S. Preventive Services Task Force (USPSTF) is a nonfederal panel of experts convened by the Agency for Health Research and Policy to systematically review the evidence for preventive services, including disease screening, and to create evidence-based recommendations for primary care practice in the United States. As rheumatologists contemplate the potential of screening for preclinical disease, understanding the process used by the USPSTF can help guide research efforts supporting such screening.
- Prevention of Rheumatic Diseases: Strategies, Caveats, and Future Directions. [REVIEW]
- Rheum Dis Clin North Am 2014 Nov; 40(4):771-785.
Rheumatic diseases affect a significant portion of the population and lead to increased health care costs, disability, and premature mortality; effective preventive measures for these diseases could lead to substantial improvements in public health. Natural history studies show that for most rheumatic diseases there is a period of preclinical disease development during which abnormal biomarkers or other processes can be detected. These changes are useful to understand mechanisms of disease pathogenesis; in addition, they may be applied to estimate a personal risk of future disease while individuals are still relatively asymptomatic and ultimately be used to identify individuals who may be targeted for preventive interventions.
- Prediction of Future Rheumatoid Arthritis. [REVIEW]
- Rheum Dis Clin North Am 2014 Nov; 40(4):753-770.
Rheumatoid arthritis (RA) results from an interaction between genetic susceptibility and environmental factors. Several of these factors are known, such as family history of RA, high birth weight, smoking, silica exposure, alcohol nonuse, obesity, diabetes mellitus, rheumatoid factor, anti-citrullinated protein antibody, and genetic variants such as the shared epitope and protein tyrosine phosphatase nonreceptor type 22. The impact of these factors can be modeled in the 2 main groups at risk of RA: family members of patients with RA and seropositive persons with or without arthralgia. Current models have the potential to select individuals for preventive strategies.
- Identification of Self-antigen-specific T Cells Reflecting Loss of Tolerance in Autoimmune Disease Underpins Preventative Immunotherapeutic Strategies in Rheumatoid Arthritis. [REVIEW]
- Rheum Dis Clin North Am 2014 Nov; 40(4):735-752.
Despite treatment advances, rheumatoid arthritis (RA) is still associated with significant disability, decreased work capacity, and reduced life expectancy. Effective immunotherapies to restore immune tolerance promise greater specificity, lower toxicity, and a longer-term solution to controlling and preventing RA. Design of effective therapies requires a fundamental understanding of the critical immunopathogenetic pathways in RA. This article reviews advances in the understanding of self-antigen-specific T cells in autoimmune diseases including RA and type 1 diabetes, which bring exciting insights to the mechanisms underpinning loss of tolerance and how tolerance could be restored for disease prevention in the preclinical or recent-onset period.
- Challenges in Imaging in Preclinical Rheumatoid Arthritis. [REVIEW]
- Rheum Dis Clin North Am 2014 Nov; 40(4):727-734.
There exists a preclinical phase to the disease progression of rheumatoid arthritis, in which there is evidence of autoimmunity but no overt clinical arthritis. Identifying patients in this phase would allow for early treatment, to potentially halt manifestation of the disease. Imaging, because it is noninvasive, provides an appealing alternative to gold-standard synovial biopsies for identification of these preclinical patients. Ultrasonography, magnetic resonance imaging, and positron emission tomography all have their advantages and disadvantages as imaging modalities in this regard. Further research into alternative imaging modalities with larger cohorts is required to determine the most effective technique.
- Mucosal Immune Responses to Microbiota in the Development of Autoimmune Disease. [REVIEW]
- Rheum Dis Clin North Am 2014 Nov; 40(4):711-725.
The etiology of most systemic autoimmune diseases remains unknown. There is often a preclinical period of systemic autoimmunity prior to the onset of clinically classifiable disease; established and emerging data suggest that dysregulated immune interactions with commensal microbiota may play a role in the initial generation of autoimmunity in this preclinical period. This article reviews potential mechanisms by which alterations of healthy microbiota may induce autoimmunity as well as mucosal microbial associations with autoimmune diseases. If mucosal microbiota lead to the development of autoimmunity, these mucosal sites, microorganisms, and immunologic mechanisms can be targeted to prevent the onset of systemic autoimmune disease.
- Identifying and Treating Preclinical and Early Osteoarthritis. [REVIEW]
- Rheum Dis Clin North Am 2014 Nov; 40(4):699-710.
Studies suggest that many persons with painful osteoarthritis already have extensive structural disease including malalignment, which may preclude successful stabilization or reversal of disease; this provides a strong rationale for developing strategies to prevent disease or to identify and treat it early. This article reviews a variety of approaches likely to capture those at high risk of or with early disease. However, given the absence of effective treatments, it is unclear whether structural disease could be successfully slowed or prevented in those with early symptoms or at high risk of disease.