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Early Rheumatoid Arthritis — Is There a Window of Opportunity?

JOHN J. CUSH

ABSTRACT.

The early diagnosis and treatment of nascent rheumatoid arthritis (RA) has become a prime objective for rheumatologists and clinicians who care for patients with arthritis. Population-based studies have consistently shown that patients with RA are at substantial risk for progressive joint damage, disability, and increased morbidity and mortality. These inevitable outcomes are closely linked to the consequences of rheumatoid inflammation, which begins early and is progressive in all. At issue is whether early diagnosis, coupled with aggressive therapy, might alter the natural history of this RA. If this "window of opportunity" exists, then outcomes should be substantially altered by delivering the right therapies at the right time. A growing body of evidence has emphasized the consistent clinical and radiographic benefits of early, aggressive treatment of RA. These studies confirm that all therapies — monotherapy, combination disease modifying antirheumatic drugs (DMARD), biologics — work better in early disease than in long-established RA. Earlier identification, referral, and an accurate diagnosis of RA can now be rewarded with highly effective DMARD or biologic therapies. Rheumatologists should rise to the challenge and educate clinicians about this window of opportunity, the potential for remission, and superior clinical responses when patients with early RA or undifferentiated arthritis are referred to and managed by experts in aggressive rheumatologic care. (J Rheumatol 2007;34 Suppl 80:1-7)

Key Indexing Terms:

EARLY DIAGNOSIS
UNDIFFERENTIATED ARTHRITIS
RHEUMATOID ARTHRITIS
RHEUMATOLOGISTS
TREATMENT
DISABILITY
MORBIDITY


From the Department of Clinical Rheumatology, Baylor Research Institute, Dallas, Texas, USA.

Dr. Cush has had consultant, investigator, and lecturer affiliations with Amgen, Wyeth, Abbott Laboratories, Centocor, UCB, Genentech, Roche, Novartis, and Pfizer.

J.J. Cush, MD, Director of Clinical Rheumatology.

Address reprint requests to Dr. J.J. Cush, Baylor Research Institute, Arthritis Care and Research Center, 9900 N. Central Expwy, Suite 550, Dallas, TX 75231. E-mail: johncush@baylorhealth.edu



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