[Preclinical intervention in rheumatoid arthritis: balancing preventive benefits and clinical risks]

Intervention in the preclinical of rheumatoid arthritis (Pre-RA) represents a core strategy for disease prevention and control. To date, there are no unified clinical standards regarding the timing and regimens of Pre-RA intervention. Non-pharmacological interventions are theoretically feasible yet lack support from high-quality randomized controlled trials. Pharmacological interventions are backed by more robust evidence-based data, though they carry both clinical benefits and potential risks. Risk stratification tools enable effective identification of patients at high risk of disease progression, though standardized clinical workflows for such tools have not yet been established. This article systematically reviews the available evidence and limitations of non-pharmacological and pharmacological interventions for pre-RA. On this basis, it comments on the clinical application of risk stratification tools and balances the benefits and risks of implementing early intervention strategies in pre-RA. Based on current evidence, a uniform strategy of aggressive intervention or watchful waiting is not recommended for the clinical management of pre-RA. Individualized precision interventions should be delivered according to risk stratification results combined with patient characteristics.