Early treatment is associated with improved outcomes in patients with rheumatoid arthritis (RA), suggesting that a 'window of opportunity', in which the disease is most susceptible to disease-modifying treatment, exists. Autoantibodies and markers of systemic inflammation can be present long before clinical arthritis, and maturation of the immune response seems to coincide with the development of RA. The pre-arthritis phase associated with symptoms such as as joint pain without clinical arthritis (athralgia) is now hypothesized to fall within the aforementioned window of opportunity. Consequently, disease modulation in this phase might prevent the occurrence of clinically apparent arthritis, which would result in a persistent disease course if untreated. Several ongoing proof-of-concept trials are now testing this hypothesis. This Review highlights the importance of adequate risk prediction for the correct design, execution and interpretation of results of these prevention trials, as well as considerations when translating these findings into clinical practice. The patients' perspectives are discussed, and the accuracy with which RA development can be predicted in patients presenting with arthralgia is evaluated. Currently, the best starting position for preventive studies is proposed to be the inclusion of patients with an increased risk of RA, such as those identified as fulfilling the EULAR definition of 'arthralgia suspicious for progression to RA'.

早期治疗与类风湿关节炎 (RA) 患者的预后改善有关，这表明存在一个“机会之窗”，该疾病最容易受到疾病改善治疗的影响。自身抗体和全身炎症标志物可以在临床关节炎之前很久就出现，免疫反应的成熟似乎与 RA 的发展一致。现在假设与症状相关的关节炎前阶段，例如没有临床关节炎（关节痛）的关节疼痛（关节痛）属于上述机会窗口。因此，这一阶段的疾病调节可能会防止临床上明显的关节炎的发生，如果不治疗，这将导致持续的病程。几个正在进行的概念验证试验正在测试这一假设。本综述强调了充分的风险预测对于正确设计、执行和解释这些预防试验结果的重要性，以及将这些发现转化为临床实践时的考虑因素。讨论了患者的观点，并评估了在出现关节痛的患者中预测 RA 发展的准确性。目前，建议进行预防性研究的最佳起点是纳入 RA 风险增加的患者，例如那些被确定为符合 EULAR 定义的“疑似进展为 RA 的关节痛”的患者。以及将这些发现转化为临床实践时的考虑。讨论了患者的观点，并评估了在出现关节痛的患者中预测 RA 发展的准确性。目前，建议进行预防性研究的最佳起点是纳入 RA 风险增加的患者，例如那些被确定为符合 EULAR 定义的“疑似进展为 RA 的关节痛”的患者。以及将这些发现转化为临床实践时的考虑。讨论了患者的观点，并评估了在出现关节痛的患者中预测 RA 发展的准确性。目前，建议进行预防性研究的最佳起点是纳入 RA 风险增加的患者，例如那些被确定为符合 EULAR 定义的“疑似进展为 RA 的关节痛”的患者。