Review maps immune and omics findings in rheumatoid arthritis prevention

Seropositive rheumatoid arthritis can be preceded by a pre-RA period in which autoantibodies, including anti-citrullinated protein antibodies and rheumatoid factors, are present before joint disease. This review summarizes hypothesis-driven and multi-omics research in people at risk of RA, alongside epidemiological findings on environmental exposures; it does not report a new clinical trial or sample size.

Studies discussed in the review have identified site- and isotype-specific autoantibody patterns, inflammation and possible dysbiosis at mucosal sites, including the lung, gut and oral or periodontal tissues. Cross-sectional and longitudinal multi-omics studies have also reported epitope spreading, pro-inflammatory biomarkers and altered peripheral blood immune-cell populations associated with autoimmunity.

The findings point to candidate mechanisms and potential therapeutic targets, but the review emphasizes that how mucosal and systemic abnormalities interact—and how they relate to clinical heterogeneity—remains unclear. The authors propose harmonized longitudinal data and AI-enabled modelling to support biomarker discovery and prevention research. These observations do not establish that a particular intervention prevents RA or justify a change in clinical practice.