How do you diagnose rheumatoid arthritis early?
There are difficulties in making an accurate diagnosis of rheumatoid arthritis in its early stages, a principal problem being the fact that its most defining feature is chronicity, which, by definition, takes time to identify. There is substantial evidence that patients with rheumatoid arthritis should be treated early, and the majority are now commenced on therapy when first diagnosed. A logical implication of the early therapy approach is that treatment before rheumatoid arthritis is fully developed may have even greater benefits. This requires patients who are likely to have a persistent, more severe disease to be identified and treated effectively in the very earliest stages. This requires a system of the early specialist referral of suitable patients and the use of effective predictors of patient outcome. This text discusses the early arthritis clinic approach and the current evidence base available for use in constructing management guidelines for such patients.
Quinn
M A
MA
Rheumatology and Rehabilitation Research Unit, University of Leeds, 36 Clarendon Road, Leeds, LS2 9JT, UK.
Green
M J
MJ
Conaghan
P
P
Emery
P
P
D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000145:classification / Q000175:diagnosis* / Q000188:drug therapy; D002097:C-Reactive Protein / Q000032:analysis; D002908:Chronic Disease; D003937:Diagnosis, Differential; D000939:Epitopes; D006684:HLA-DR Antigens / Q000235:genetics; D059811:HLA-DRB1 Chains; D006801:Humans; D011379:Prognosis; D012217:Rheumatoid Factor / Q000032:analysis; D013585:Synovitis / Q000175:diagnosis / Q000188:drug therapy; D013997:Time Factors
D018501:Antirheumatic Agents; D000939:Epitopes; D006684:HLA-DR Antigens; D059811:HLA-DRB1 Chains; D002097:C-Reactive Protein; D012217:Rheumatoid Factor