How do you diagnose rheumatoid arthritis early?

There are difficulties in making an accurate diagnosis of rheumatoid arthri tis in its early stages, a principal problem being the fact that its most d efining feature is chronicity, which, by definition, takes time to identify . There is substantial evidence that patients with rheumatoid arthritis sho uld be treated early, and the majority are now commenced on therapy when fi rst diagnosed. A logical implication of the early therapy approach is that treatment before rheumatoid arthritis is fully developed may have even grea ter benefits. This requires patients who are likely to have a persistent, m ore severe disease to be identified and treated effectively in the very ear liest stages. This requires a system of the early specialist referral of su itable patients and the use of effective predictors of patient outcome. Thi s text discusses the early arthritis clinic approach and the current eviden ce base available for use in constructing management guidelines for such pa tients.