Abstract
Established and emerging data demonstrate that a ‘preclinical’ period of disease precedes the onset
of clinical rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), as well as other
autoimmune rheumatic diseases (ARDs).This preclinical stage of development of disease is
characterized by abnormalities in disease-related biomarkers before the onset of the clinically
apparent signs and symptoms. Numerous genetic and environmental risk factors for ARDs have
also been identified, and many of these factors are likely to act before the clinical appearance of
tissue injury to initiate and/or propagate autoimmunity and autoimmune disease. Thus, biomarkers
representative of these autoimmune processes could potentially be used in conjunction with other
clinical parameters during the preclinical period of ARDs to predict the future development of
clinically apparent disease. This Review focuses on the preclinical stages of RA and SLE, as our
current understanding of these diseases can be used to present an overall model of the
development of ARDs that might ultimately be used to develop screening programmes and
preventive strategies. Important considerations for the future development of such approaches, in
particular, the issues that require additional research and how they might be addressed, are also
discussed.
Abstract
Established and emerging data demonstrate that a ‘preclinical’ period of disease precedes the onset
of clinical rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), as well as other
autoimmune rheumatic diseases (ARDs).This preclinical stage of development of disease is
characterized by abnormalities in disease-related biomarkers before the onset of the clinically
apparent signs and symptoms. Numerous genetic and environmental risk factors for ARDs have
also been identified, and many of these factors are likely to act before the clinical appearance of
tissue injury to initiate and/or propagate autoimmunity and autoimmune disease. Thus, biomarkers
representative of these autoimmune processes could potentially be used in conjunction with other
clinical parameters during the preclinical period of ARDs to predict the future development of
clinically apparent disease. This Review focuses on the preclinical stages of RA and SLE, as our
current understanding of these diseases can be used to present an overall model of the
development of ARDs that might ultimately be used to develop screening programmes and
preventive strategies. Important considerations for the future development of such approaches, in
particular, the issues that require additional research and how they might be addressed, are also
discussed.
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