For many people, rheumatoid arthritis seems to appear suddenly. One day they begin experiencing painful, swollen joints, overwhelming fatigue, and stiffness that makes everyday activities difficult.
But scientists now know that the disease often starts developing long before the first diagnosis is made.
New research from King’s College London suggests that treating people before rheumatoid arthritis fully develops could significantly delay the disease. The findings, published in The Lancet Rheumatology, show that a one-year course of a medication called abatacept delayed the onset of rheumatoid arthritis in people who were considered at high risk.
The study is important because there are currently no approved treatments specifically designed to prevent rheumatoid arthritis. Most available therapies are given after the disease has already developed and begun damaging the joints.
Rheumatoid arthritis is an autoimmune disease. In autoimmune diseases, the immune system mistakenly attacks healthy tissues instead of protecting the body from infections.
In rheumatoid arthritis, the immune system primarily targets the joints, causing inflammation, pain, swelling, and stiffness. Over time, this ongoing inflammation can damage cartilage and bone, leading to disability and reduced quality of life.
The condition affects hundreds of thousands of people in the United Kingdom and millions worldwide. It can affect people of all ages but often develops during middle adulthood. Many people experience years of pain, fatigue, and difficulty working or carrying out normal daily activities.
Researchers have recently become interested in identifying people who are likely to develop rheumatoid arthritis before symptoms become severe.
Certain blood tests can detect antibodies that appear years before the disease is officially diagnosed. These antibodies act as warning signs that the immune system may already be heading in the wrong direction.
The research team followed 213 participants from the United Kingdom and the Netherlands who were considered at high risk of developing rheumatoid arthritis. Some participants received abatacept for one year, while others received a placebo treatment.
Abatacept is a biologic medicine that works by modifying the activity of the immune system. It is already used to treat people who have established rheumatoid arthritis, but researchers wanted to know whether it could be useful even earlier in the disease process.
The original trial followed participants for two years. The new study extended that follow-up period to between four and eight years, making it one of the longest studies ever conducted in people at risk of rheumatoid arthritis.
The results were encouraging. People who received abatacept developed rheumatoid arthritis much later than those who received placebo. In some cases, the disease was delayed by as much as four years after treatment had ended.
The medication did not completely prevent rheumatoid arthritis. Many participants eventually developed the disease. However, delaying the condition by several years could still have major benefits for patients. Fewer years living with symptoms may mean less pain, less disability, and fewer disruptions to work and family life.
The greatest benefits were seen among participants who had the highest risk of developing rheumatoid arthritis. These individuals were identified using blood tests that detected disease-related antibodies. Interestingly, the people most likely to develop the disease were also the ones who benefited most from treatment.
During the treatment period, participants reported improvements in symptoms such as joint pain, fatigue, and overall wellbeing. However, once treatment stopped, these symptom improvements gradually faded and became similar to those seen in the placebo group. This suggests that continued treatment may be needed to maintain symptom relief.
The researchers also found reassuring safety results. Serious side effects occurred at similar rates in both the abatacept and placebo groups, and no new safety concerns emerged during the long-term follow-up.
This study provides some of the strongest evidence so far that autoimmune diseases may be modified before they fully develop. The long follow-up period is a major strength because it allowed researchers to observe whether the benefits lasted after treatment ended.
However, abatacept delayed rather than completely prevented rheumatoid arthritis, meaning more research is needed to determine whether longer treatment or different strategies could provide even greater protection.
The findings support a growing shift toward identifying high-risk individuals early and intervening before permanent joint damage occurs.
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Source: King’s College London.
