Pre-Rheumatoid Arthritis: A Review

Abstract

Pre-rheumatoid arthritis (pre-RA) is the preclinical period before the diagnosis of rheumatoid arthritis (RA). Patients may suffer from arthralgia without clinically detectable arthritis. This period is characterized by a complex interaction of genetic, environmental, and host microbiomic factors leading to immune dysregulation, the production of autoantibodies, and finally joint inflammation. Around 30% of patients with undifferentiated arthritis progress to RA. Early identification of patients at the pre-RA stage might provide an opportunity for timely intervention, which may alter the natural history of the disease. In this narrative review, we will summarize the clinical features of pre-RA and the risk factors associated with the development of RA. The management of patients with a high risk of developing RA will also be discussed.