Evaluating patients with arthritis of recent onset - Studies in pathogenesis and prognosis

Inflammatory synovitis of recent onset poses a diagnostic and prognostic ch allenge to primary care physicians and rheumatologists, A lack of understan ding of the underlying etiologic and pathogenic processes limits the abilit y to distinguish forms of arthritis that follow a benign, self-limiting cou rse from forms that proceed to an aggressive, erosive disease requiring int ensive immunosuppressive therapy. It is estimated that between 30% and 40% of patients presenting with early synovitis have disease that remains uncla ssified. Using data from a cohort of patients with early synovitis and revi ewing current literature, we discuss investigational approaches toward a ne w classification of patients with early synovitis. Although a lack of under standing of this heterogeneous clinical syndrome has led clinicians to take a largely empirical approach to treatment thus far, the evolving awareness of disease predisposition at a genetic level and the expanding ability to specifically manipulate biological pathways may ultimately change the appro ach to this clinical problem.