REVIEW - Early RA

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Medscape

Posted 05/09/2006

Early Rheumatoid Arthritis

Klaus P Machold; Nell; Tanja Stamm; Aletaha; f S Smolen

Abstract

Purpose of Review: This review provides novel and updated information

on pathogenesis, referral, and clinical characteristics as well as

therapeutic approaches in early rheumatoid arthritis.

Recent Findings: Early referral is important, but new classification

criteria for early rheumatoid arthritis need to be elaborated.

Predictive markers for rheumatoid arthritis are still confined to

autoantibodies; respective algorithms have been presented. Other

biomarkers will still have to prove their usefulness. Magnetic

resonance imaging and sonography do not appear to sufficiently

distinguish between early rheumatoid and nonrheumatoid arthritis.

Rheumatoid arthritis has become milder at presentation in recent

years. In its very early stages, the cytokine profile reflects T-cell

activation and switches to abundant proinflammatory cytokines

thereafter. Disease-modifying antirheumatic drugs plus glucocorticoids

are highly effective, as is early use of tumor necrosis factor

blockers plus methotrexate. Tight control of disease activity and

subsequent therapeutic adjustments are highly effective. Disease

activity indices that are simple to calculate have been presented and

validated. Early intensive therapy may lead to decrease in disability

and cost reduction in rheumatoid arthritis.

Summary: Understanding of early arthritis is increasing, especially in

prognostic and therapeutic respects, and new treatment strategies

appear to improve the outcome in patients with early arthritis.

Nevertheless, much remains to be studied to better address the issue

of early rheumatoid arthritis.

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Read the entire article here:

http://www.medscape.com/viewarticle/530072_1

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Not an MD