Evaluating patients with arthritis of recent onset: studies in pathogenesis and prognosis.
Inflammatory synovitis of recent onset poses a diagnostic and prognostic challenge to primary care physicians and rheumatologists. A lack of understanding of the underlying etiologic and pathogenic processes limits the ability to distinguish forms of arthritis that follow a benign, self-limiting course from forms that proceed to an aggressive, erosive disease requiring intensive immunosuppressive therapy. It is estimated that between 30% and 40% of patients presenting with early synovitis have disease that remains unclassified. Using data from a cohort of patients with early synovitis and reviewing current literature, we discuss investigational approaches toward a new classification of patients with early synovitis. Although a lack of understanding of this heterogeneous clinical syndrome has led clinicians to take a largely empirical approach to treatment thus far, the evolving awareness of disease predisposition at a genetic level and the expanding ability to specifically manipulate biological pathways may ultimately change the approach to this clinical problem. JAMA. 2000;284:2368-2373.
El-Gabalawy
H S
HS
Bldg 10, Room 9S205, National Institutes of Health, Bethesda, MD 20892, USA. elgabala@exchange.nih.gov
Duray
P
P
Goldbach-Mansky
R
R
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001168:Arthritis / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D016918:Arthritis, Reactive / Q000175:diagnosis; D001172:Arthritis, Rheumatoid / Q000175:diagnosis; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013585:Synovitis / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy
D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids