Established rheumatoid arthritis

Currently the diagnosis of rheumatoid arthritis (RA) may be difficult; the ACR criteria appear most sensitive and specific in long-standing disease. W ithout clear definition or diagnostic criteria for early disease it is diff icult to define late or established RA. The distinction between early and e stablished RA has been further blurred by recent imaging studies that sugge st even in what is currently termed early disease, there is evidence of joi nt damage. The natural history of RA suggests that most patients with clini c-diagnosed RA have a progressively disabling course, but evidence is growi ng that modern therapeutic strategies result in better long-term outcomes, especially when applied early in the disease course. In established disease , quantitative markers such as C-reactive protein (CRP) give prognostic inf ormation, but in the pre-erosive, early phase of the disease the qualitativ e markers such as rheumatoid factor (RF) and shared epitope are crucial. As rheumatologists, our major ai ms must remain: ( I) to diagnose the disease as early as possible; (2) to identify those patients with poor prognosis w ho will benefit most from targeted therapy; and (3) to aim for more intensi ve disease control irrespective of disease duration.