title: Treating very early rheumatoid arthritis.
abstract: Rheumatoid arthritis (RA) is common and leads to joint damage due to persistent synovitis. The persistence of inflammation is maintained by hyperplastic stromal tissue, which drives the accumulation of leukocytes in the synovium. Aggressive treatment after the first 3-4 months of symptoms, with either disease modifying anti-rheumatic drugs or anti-tumor necrosis factor (TNF)-alpha therapy, reduces the rate of disease progression. However, it rarely switches off disease such that remission can be maintained without the continued need for immunosuppressive therapy. There is increasing evidence that the first few months after symptom onset represent a pathologically distinct phase of disease. This very early phase may translate into a therapeutic window of opportunity during which it may be possible to permanently switch off the disease process. The rationale for, and approaches to, treatment within this very early window are discussed.
authors.affiliation: Rheumatology Research Group, Division of Immunity and Infection, Institute of Biomedical Research, MRC Centre for Immune Regulation, University of Birmingham, Birmingham B15 2TT, UK. k.raza@bham.ac.uk
authors.forename: Karim
authors.initials: K
authors.lastname: Raza
authors.forename: Caitriona E
authors.initials: CE
authors.lastname: Buckley
authors.forename: Mike
authors.initials: M
authors.lastname: Salmon
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Buckley
mesh_terms: D000906:Antibodies / Q000032:analysis; D018501:Antirheumatic Agents / Q000627:therapeutic use; D017209:Apoptosis / Q000276:immunology; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000473:pathology / Q000628:therapy*; D018450:Disease Progression; D006801:Humans; D007962:Leukocytes / Q000473:pathology / Q000502:physiology; D009504:Neutrophils / Q000276:immunology; D010456:Peptides, Cyclic / Q000276:immunology; D012074:Remission Induction; D012217:Rheumatoid Factor / Q000032:analysis; D013585:Synovitis / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D000906:Antibodies; D018501:Antirheumatic Agents; D010456:Peptides, Cyclic; D014409:Tumor Necrosis Factor-alpha; C487763:cyclic citrullinated peptide; D012217:Rheumatoid Factor