Rheumatic diseases affect a significant portion of the population and lead to increased health care costs disability and even premature mortality; as such effective preventive steps for these diseases could lead to substantial improvements in public health. screening and preventive interventions that incorporate disease biology as well as ethical and public health concerns. Keywords: Prevention Rheumatic Diseases Introduction Across the multiple fields of medicine there is increasing interest in preventive approaches to disease. To help guideline preventive approaches to disease in the 1960’s the World Health Organization put forward recommendations for disease screening and prevention as listed in Table 1 (1). Overall these recommendations suggest that diseases targeted for screening and prevention should have an Epirubicin Hydrochloride important impact on health an identifiable asymptomatic (or minimally symptomatic period) during which individuals at high-risk for future disease Epirubicin Hydrochloride can accurately be identified and that there be available an effective means for preventing the further evolution of disease. Screening and prevention approaches that follow these guidelines are in action for many diseases. For example across the globe there is considerable effort put forward to screen and prevent adverse outcomes from cardiovascular disease and many types of cancer as well as programs to prevent many infectious diseases. Table 1 WHO recommendations regarding screening and prevention for a disease Epirubicin Hydrochloride While most rheumatologists would agree that rheumatic diseases on the whole are important health problems and meet several of the other WHO criteria for screening many key questions regarding prevention of rheumatic diseases are still unanswered. However given the growing understanding of the etiologies rheumatic disease and as discussed herein a growing awareness that many rheumatic diseases have a period of relatively asymptomatic disease development during which there are abnormalities of biomarkers that can be used to predict future risk for disease (2) there is hope that rheumatic diseases could join the list of preventable diseases. In this review we will discuss some general principles of disease prevention applicable to rheumatic disease and outline a potential research strategy for the development of effective Epirubicin Hydrochloride preventive strategies that are able to reduce the adverse impact of these diseases. General strategies for disease prevention Prevention strategies are typically categorized into Rabbit Polyclonal to BCAS3. primary secondary or tertiary interventions (Physique 1) (3 4 The aim of primary prevention is to avoid the development of disease by eliminating specific risk factors or increasing individual’s resistance to the condition. An example of this type of approach is usually vaccines against infections. The aim of secondary prevention is to reduce the progression from a latent or asymptomatic phase of disease to symptomatic disease. Thus a secondary preventive intervention attempts to interrupt the mechanisms of disease development before they evolve into an apparent illness. Examples of this type of approach include early identification of cancers through programs such as mammograms and colonoscopies. Figure 1 Natural history of rheumatic disease and possibilities for prevention The aim of tertiary prevention is to delay or to limit the impact of an established disease (5). This is where most rheumatic diseases are currently dealt with where rheumatologists are typically performing tertiary prevention by attempting to prevent progression of disease to disability or premature death after a patient present with clinically apparent disease (e.g. swollen joints in RA or skin rash in SLE). However rheumatologists are less used to carry out primary or secondary preventive interventions for rheumatic diseases. As knowledge of the risk factors for rheumatic diseases is growing (e.g. smoking for rheumatoid arthritis (RA))(6) primary prevention may become more of a priority for rheumatic diseases. Potential primary preventive strategies Environmental risk factors are of great interest for a preventive strategy of rheumatic diseases as they are potentially modifiable. In particular lifestyle modifications are a common request from at risk populations; specifically when individuals at high-risk for RA were interviewed about potential preventive interventions the majority primarily mentioned way of life adjustments as approaches that they would be comfortable with (7). Multiple environmental and way of life factors have been identified for rheumatic diseases. In RA tobacco smoking is the best-established.