Primordial and primary prevention in rheumatological diseases: The time has come

Abstract

Rheumatological, immune-mediated diseases (RDs) impose a substantial global burden, especially on women of working age, resulting in chronic disability and escalating healthcare utilisation. Despite therapeutic advances, the incidence of RDs is rising, and no definitive cure exists. Emerging evidence highlights the potential of early-stage interventions, such as addressing preclinical phases of diseases to delay or prevent disease onset. Modifiable risk factors, such as tobacco use, obesity, diet, infections, mechanical strain, and other environmental exposures (e.g., air pollution and ultraviolet radiation), offer clear targets for intervention. Despite increasing efforts in producing high-quality studies for each rheumatological condition, current evidence supports the global promotion of a healthy lifestyle with a balanced diet, regular physical activity and vaccinations, vitamin D supplementation, and minimisation of excessive infectious, mechanical and psychosocial strain. However, to stimulate stakeholders and policymakers in investing and developing strategies for primary prevention, further interventional trials are warranted on at-risk populations such as first-degree relatives of rheumatological patients and asymptomatic autoantibody carriers. Indeed, besides encouraging experiments in rheumatoid arthritis and psoriatic arthritis, where research has reached the adolescent stage, research in disease interception is still in its infancy for most rheumatological conditions.