Individuals at risk of rheumatoid arthritis: evaluating phenotypes and predictors of disease

Clinical outcomes in patients with rheumatoid arthritis (RA) are substantially improved by early therapeutic intervention; however many individuals still develop co-morbidities with a significant socio-economic costs. In other conditions, there is a focus on disease prevention. Identification of the earliest signs of disease, or even those at risk of disease, remains challenging due to the heterogeneity of presentations and the complexities of RA pathogenesis. In working towards RA prevention an understanding of the pathology prior to clinical disease is required. If risk of subsequent disease could be accurately quantified, the opportunity to intervene with therapy that might delay or even prevent disease becomes feasible.

This thesis outlines a programme of work primarily focusing on individuals with systemic autoimmunity, but no synovitis. By studying an ‘at-risk’ group, the stages and phenotypes prior to disease can be described. Clinical, imaging, molecular and cellular biomarkers will be considered in an attempt to characterise individuals risk and assist in the prediction of RA development.