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Clinical approaches to early inflammatory arthritis

Nature Reviews Rheumatology volume 5, pages 627–633 (2009)Cite this article

Abstract

Several advances have been made in the understanding of the pathogenesis, as well as in the clinical evaluation and treatment, of early inflammatory arthritis. The presence of anti-citrullinated protein antibodies (ACPAs) has emerged as a major new biomarker for use in clinical practice. The presence of ACPAs can be used to divide patients with early arthritis into subsets that are phenotypically similar but have varying pathogenetic and prognostic features. Although the detection of ACPAs is a major development in the diagnosis and prognosis of rheumatoid arthritis (RA), prediction of the outcome of arthritis at the individual level can still be much improved. For patients diagnosed with RA, and who have active polyarthritis, treatment is not dependent on the assessment of prognostic factors, as these patients are best treated with combination therapy; over 40% of these patients achieve remission with such treatment. In patients who present with oligoarthritis, however, management should be based on the assessment of prognostic factors. The success of early treatment of inflammatory arthritis and the recognition of a measurable preclinical phase of RA offer hope that treating the disease before it becomes clinically active might be possible.

Key Points

  • Established laboratory markers for early arthritis include increased levels of C-reactive protein, an increase in the erythrocyte sedimentation rate and the presence of rheumatoid factor

  • The detection of anti-citrullinated protein antibodies is a major development in the diagnosis and prognosis of rheumatoid arthritis

  • New promising techniques for diagnosis of early arthritis include the use of cytokine and genetic profiles and the imaging of joint damage and inflammation with ultrasonography and MRI

  • Improving prognostication at the individual level will be necessary to improve management of early arthritis

  • Increasing the rate of remission for a majority of patients and lessening the rate of adverse effects are important goals

  • Another major goal of treatment is to develop effective intervention in the preclinical or athralgia phase

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  1. Department of Rheumatology, Jan van Breemen Institute, Amsterdam, The Netherlands

    Dirkjan van Schaardenburg

  2. Department of Rheumatology, Free University Medical Center, Amsterdam, The Netherlands

    Ben A. C. Dijkmans

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Correspondence to Dirkjan van Schaardenburg.

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Dirkjan van Schaardenburg declares that he has received grant or research support from Abbott.

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van Schaardenburg, D., Dijkmans, B. Clinical approaches to early inflammatory arthritis. Nat Rev Rheumatol 5, 627–633 (2009). https://doi.org/10.1038/nrrheum.2009.203

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