When does rheumatoid arthritis start and can it be stopped before it does?

Content Provider	Semantic Scholar
Author	Bykerk, Vivian P. Hazes, Johanna Maria Wilhelmina
Copyright Year	2010
Abstract	Rheumatoid arthritis (RA) is characterised by a persistent and often destructive polyarticular synovitis involving large and small joints not infrequently associated with extra-articular features. This construct was classified by the American Rheumatism Association (ARA) 1987 classification criteria for RA.1 However, RA probably has a long prodrome with an asymptomatic phase followed by a period of unclassifiable musculoskeletal symptoms and signs before fully manifesting four out of seven of these criteria. Current concepts of pathogenesis presume that environmental triggers interact with genes such as those from the histocompatibility complex where an arthritogenic peptide triggers the innate immune response followed by upregulation of adaptive immunity.2 This would represent the preclinical phase of RA during which anti-citrullinated peptide antibodies (ACPAs) and then IgM-rheumatoid factor (IgM-RF) are generated. During this adaptive immune response, profound changes occur in the synovial membrane, leading to an influx of immune and inflammatory cells and increased vascularity of the joints followed by a destructive synovitis.2 Ultimately, patients develop a sufficient burden of synovitis that it is classifiable as RA. It is not easy to identify when RA actually starts clinically but it may be important to recognise preclinical RA at a much earlier time point in order to prevent progression to full-blown classifiable disease which becomes persistent and destructive. Starting from the presence of early arthritis or undifferentiated arthritis (UA) several prediction models to predict the development of RA—however, defined—have been derived. In all models the presence of ACPAs is an independent strong predictor of the development of RA.3,–,6 Recently, researchers have attempted to identify patients in the prodromal phase during a period of very early inflammatory arthritis (VEIA) to determine if there are predictors that may indicate which patients go on to develop RA and if there is any treatment …
File Format	PDF HTM / HTML
DOI	10.1136/ard.2009.116020
PubMed reference number	20215139
Journal	Medline
Volume Number	69
Issue Number	3
Alternate Webpage(s)	http://ard.bmj.com/content/annrheumdis/69/3/473.full.pdf
Alternate Webpage(s)	https://doi.org/10.1136/ard.2009.116020
Journal	Annals of the rheumatic diseases
Language	English
Access Restriction	Open
Content Type	Text
Resource Type	Article