title: Rheumatoid arthritis--early diagnosis and disease management.
abstract: BACKGROUND
  0.5% to 0.8% of all adults suffer from rheumatoid arthritis (RA). The main considerations for persons with new-onset RA are early diagnosis, disease-modifying anti-rheumatic drugs (DMARDs), remission, and interdisciplinary treatment.
  
  
  METHODS
  As part of the process of creating a new S3 guideline on the management of early RA and a new S1 guideline on stage-adapted pharmacotherapy for RA, the authors conducted a selective search and review of the literature and specifically updated it to 20 March 2013.
  
  
  RESULTS
  In patients presenting with joint inflammation, the diagnosis of RA can be directly confirmed (positive predictive value, 85% to 97%), and its prognosis assessed, on the basis of the following findings: joint examination, acute phase reaction, serology (rheumatoid factor [RF], antibody against citrullinated peptides/proteins [ACPA], and duration of symptoms (ACR/Eular classification criteria, 2010). Early, remission-oriented and adapted treatment with DMARDs ("treating to target") leads to several years of normal bodily function without disability in 40% to 60% of patients. Treatment by an interdisciplinary team promotes the achievement of this goal. The risks associated with this form of treatment are low, with a dropout rate of less than 1 per 100 patient-years. Life-threatening complications are rare.
  
  
  CONCLUSIONS
  Early diagnosis, intervention with DMARDs in the first three months of disease, and the achievement of a remission minimize the adverse sequelae of RA. The sequential introduction of DMARDs, including biological agents in non-responders, as part of a treat-to-target concept optimizes the long-term outcome, as has been demonstrated in clinical trials for periods of up to eight years.
authors: Department of Rheumatology, Düsseldorf University Hospital, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany. schneider@rheumanet.org
authors: Matthias
authors: M
authors: Schneider
authors: Klaus
authors: K
authors: Krüger
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000628:therapy*; D001688:Biological Products / Q000627:therapeutic use*; D042241:Early Diagnosis; D019317:Evidence-Based Medicine; D005858:Germany; D006801:Humans; D017410:Practice Guidelines as Topic; D012219:Rheumatology / Q000592:standards*
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products
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