medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2025-285medsovet-9319Research ArticleРЕВМАТОЛОГИЯRHEUMATOLOGYДоклинический ревматоидный артрит: современный взгляд на патогенез и возможности профилактикиPreclinical rheumatoid arthritis: A modern view of the pathogenesis and possibilities of preventionhttps://orcid.org/0000-0002-1833-5357АроноваЕ. С.AronovaE. S.

Аронова Евгения Сергеевна - к.м.н., научный сотрудник лаборатории коморбидных инфекций и вакцинопрофилактики.

115522, Москва, Каширское шоссе, д. 34А

Evgeniya S. Aronova - Cand. Sci. (Med.), Researcher at the Laboratory of Comorbid Infections and Vaccine Prevention.

34А, Kashirskoe Shosse, Moscow, 115522

eugpozd@mail.ruhttps://orcid.org/0000-0001-7091-2054БеловБ. С.BelovB. S.

Белов Борис Сергеевич - д.м.н., профессор, заведующий лабораторией коморбидных инфекций и вакцинопрофилактики, Научноисследовательский институт ревматологии имени В.А. Насоновой.

115522, Москва, Каширское шоссе, д. 34А

Boris S. Belov - Dr. Sci. (Med.), Head of the Laboratory of Comorbid Infections and Vaccine Prevention.

34А, Kashirskoe Shosse, Moscow, 115522

belovbor@yandex.ruhttps://orcid.org/0000-0002-0928-3911ГридневаГ. И.GridnevaG. I.

Гриднева Галина Игоревна - к.м.н., научный сотрудник лаборатории коморбидных инфекций и вакцинопрофилактики.

115522, Москва, Каширское шоссе, д. 34А

Galina I. Gridneva - Cand. Sci. (Med.), Researcher at the Laboratory of Comorbid Infections and Vaccine Prevention.

34А, Kashirskoe Shosse, Moscow, 115522

gigridneva@mail.ruНаучно-исследовательский институт ревматологии имени В.А. НасоновойРоссияNasonova Research Institute of RheumatologyRussian Federation202508082025012172181Copyright © Аронова Е.С., Белов Б.С., Гриднева Г.И., 20252025Аронова Е.С., Белов Б.С., Гриднева Г.И.Aronova E.S., Belov B.S., Gridneva G.I.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/9319

Ревматоидный артрит (РА) представляет собой хроническое аутоиммунное заболевание с многофакторной патогенетической основой, характеризующееся прогрессивным развитием, предшествующим клиническим проявлениям. Рассмотрена естественная история заболевания, включающая этапы от генетической предрасположенности и воздействия внешних провоцирующих факторов до формирования доклинического аутоиммунитета и последующего воспалительного поражения суставов. Центральную роль в патогенезе играет взаимодействие ключевых генетических детерминант, таких как аллели HLA-DRB1, с экзогенными триггерами, включая курение и инфекционные факторы, приводящее к продукции специфических аутоантител – антицитруллинированных белковых антител и ревматоидного фактора. Эти серологические маркеры могут регистрироваться за годы до появления суставных симптомов, что указывает на длительный доклинический период заболевания. Продромальные этапы РА, сопровождающиеся системным воспалением и иммунной дисрегуляцией, рассматриваются как критические «окна возможностей» для профилактических мероприятий, направленных на предотвращение перехода заболевания в клинически выраженную фазу. Особую важность приобретают исследования, направленные на восстановление иммунологической толерантности и модуляцию микробиома, что открывает перспективы для разработки инновационных терапевтических подходов. Они должны быть ориентированы на предотвращение заболевания на самых ранних этапах его патогенеза, задолго до появления клинических признаков. Кроме того, разработка методов визуализации субклинических изменений и уточнение критериев стратификации риска станут критически важными для идентификации лиц, нуждающихся в целенаправленном воздействии. Современные принципы первичной и вторичной профилактики включают модификацию факторов риска (отказ от курения табака, коррекцию микробиома и диеты). Эти подходы открывают перспективы для снижения заболеваемости РА среди лиц с генетической предрасположенностью или наличием иммунологических маркеров на доклинической стадии заболевания.

Rheumatoid arthritis (RA) is a chronic autoimmune disease with a multifactorial pathogenetic basis, characterized by progressive development preceding clinical manifestation. This review examines the natural history of the disease, including stages from genetic predisposition and exposure to external provoking factors to the formation of preclinical autoimmunity and subsequent inflammatory joint damage. The central role in pathogenesis is played by the interaction of key genetic determinants, such as HLA-DRB1 alleles, with exogenous triggers, including smoking and infectious agents, leading to the production of specific autoantibodies – anticitrullinated protein antibodies and rheumatoid factor. These serological markers can be recorded years before the onset of joint symptoms, indicating a long preclinical period of the disease. Prodromal stages of RA, accompanied by systemic inflammation and immune dysregulation, are considered as critical “windows of opportunity” for preventive measures aimed at preventing the disease from progressing to a clinically expressed phase. Of particular importance are studies aimed at restoring immunological tolerance and modulating microbiomes, which opens up prospects for the development of innovative therapeutic approaches. These strategies should be aimed at preventing disease at the earliest stages of its pathogenesis, long before clinical manifestation. In addition, the development of methods for visualizing subclinical changes and refining risk stratification criteria will be critical for identifying individuals in need of targeted measures. Current strategies of primary and secondary prevention include risk factor modification (smoking cessation, microbiome and diet correction). These approaches offer prospects for reducing the incidence of RA among individuals with a genetic predisposition or the presence of immunological markers in the preclinical stage of the disease.

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The authors declare that there are no conflicts of interest present.