Early rheumatoid arthritis

Abstract

Background: This review outlines current knowledge of diagnosis, assessment, treatment and risk factors for early rheumatoid arthritis (RA).

Methods: Selective review of current literature was obtained by searching the terms 'rheumatoid arthritis' and 'early'.

Results: Three issues dominate the current views on early RA. First, its recognition may be difficult. Many experts consider that early inflammatory arthritis should only be classified as RA after several months' of observation. Secondly, there is emphasis on early intensive treatment with conventional disease-modifying drugs or biologics, especially tumour necrosis factor inhibitors. Thirdly, there is a debate on the risk factors with evidence of genetic risks and environmental factors like smoking that may trigger RA. Developing citrullinated proteins followed by anti-cyclic citrullinated peptide antibodies, specific for RA, appears to be a crucial pathogenetic step.

Discussion: Early RA needs immediate specialist assessment and review. Early intensive therapy is effective but needs to be focussed on patients mostly at risk of severe progressive disease.