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British Medical Bulletin Advance Access originally published online on May 31, 2007
British Medical Bulletin 2007 81-82(1):97-114; doi:10.1093/bmb/ldm011
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© The Author 2007. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org

Early rheumatoid arthritis

David L. Scott*

Department of Rheumatology, King's College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK

* Correspondence to: Department of Rheumatology, King's College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK E-mail: david.l.scott{at}kcl.ac.uk

Background: This review outlines current knowledge of diagnosis, assessment, treatment and risk factors for early rheumatoid arthritis (RA).

Methods: Selective review of current literature was obtained by searching the terms ‘rheumatoid arthritis’ and ‘early’.

Results: Three issues dominate the current views on early RA. First, its recognition may be difficult. Many experts consider that early inflammatory arthritis should only be classified as RA after several months' of observation. Secondly, there is emphasis on early intensive treatment with conventional disease-modifying drugs or biologics, especially tumour necrosis factor inhibitors. Thirdly, there is a debate on the risk factors with evidence of genetic risks and environmental factors like smoking that may trigger RA. Developing citrullinated proteins followed by anti-cyclic citrullinated peptide antibodies, specific for RA, appears to be a crucial pathogenetic step.

Discussion: Early RA needs immediate specialist assessment and review. Early intensive therapy is effective but needs to be focussed on patients mostly at risk of severe progressive disease.

Keywords: Rheumatoid arthritis • early assessment • disease-modifying drugs • biologics

Accepted for publication April 16, 2007.


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