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Population-based screening for ACPAs: a step in the pathway to the prevention of rheumatoid arthritis?
  1. Michael Mahler
  1. Correspondence to Dr Michael Mahler, Research, Inova Diagnostics, 9900 Old Grove Road, San Diego, CA 92131, USA; mmahler{at}

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Anticitrullinated protein/peptide antibodies (ACPAs), in addition to rheumatoid factor (RF), represent a serological hallmark in the diagnosis of rheumatoid arthritis (RA). In this context and with interest I read the recent article by van Zanten et al1 summarising the results from the Dutch ‘Lifelines Study’, a large population-based study of 40 132 individuals. In this setting and using an adjusted cut-off for the ACPA assay, the prevalence of ACPAs was 1.0% and associated older age, female gender, smoking, joint complaints, RA and first-degree relatives with rheumatism.

The early identification of patients in the preclinical phase of RA is of high importance as it became evident during the last decade that early intervention can prevent joint damage in patients with RA. Consequently, several ongoing studies are focused on the prevention of RA based on the treatment of individuals at high risk to develop RA.2 All these prevention trials leverage the concept of the ‘window of opportunity’ to prevent or delay the clinical ravages and attending healthcare expenditures associated with RA. Although a …

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