Rheumatoid Arthritis

Full Papers; Authors: Maria Mauermann, Kristina Hochauf-Stange, Alexander Kleymann, Karsten Conrad, Martin Aringer

Many viral infections are accompanied by joint pain and even joint swelling, notably Parvovirus and Chikungunya. The presence of fever and rashes are clues. The arthritis is typically self-limiting, and treatment with NSAIDs is usually adequate.

A prospective study of 136 people who were CCP+, but who had no clinical evidence of synovitis, examined what factors may predict future development of…

“Minority Report” is one of my all-time favourite movies. In it, the “pre-crime” law enforcement division incarcerates “pre-criminals” based on the corroborating visions of 3 “pre-cognitives”. It of course questions the ethics of pre-judgment.
The anti-CCP test is fairly well-established as a predictor of the eventual development of Rheumatoid Arthritis, as well as being prognostic of aggressive and destructive disease. However, the benefit of pre-emptive treatment based solely on a positive test but before the manifestation of clinical disease is far from established, and therefore controversial since treatments are not without possible side-effects.
The PROMPT study in 2007 suggested that treatment of early undifferentiated inflammatory arthritis with MTX delayed the progression to full-blown RA in anti-CCP positive patients, but that was in the era before the classification criteria for RA was “relaxed” in 2010. One may argue that most of the “pre-RA” patients would have fulfilled the revised criteria, and MTX usage was therapeutic and not pre-emptive.
This current study, however, goes further back, demonstrating that people who tested positive for anti-CCP and whose ultrasound showed up inflammation (even though they were asymptomatic and the doctors did not detect any synovitis clinically), these would eventually develop inflammatory arthritis which met the revised criteria for RA. Treatment at this pre-clinical stage will indeed be pre-emptive.