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Rheumatology Advance Access published online on December 18, 2007
Rheumatology, doi:10.1093/rheumatology/kem257
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© The Author 2007. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Review

Clinical identification and treatment of a rapidly progressing disease state in patients with rheumatoid arthritis

P. Emery, I. B. McInnes1, R. van Vollenhoven2 and M. C. Kraan3

Academic Unit of Musculoskeletal Disease, Leeds University, Leeds, UK. 1Experimental Medicine, Centre for Rheumatic Diseases, University of Glasgow, Glasgow, UK, 2Rheumatology, Karolinska University Hospital, Stockholm, Sweden and 3Immunology, Global Medical Affairs, Schering-Plough, Kenilworth, NJ, USA

Correspondence to: P. Emery, Head of Academic Unit of Musculoskeletal Disease, Leeds University, Clinical Director, Chapel Town Road, Leeds LS7 4S, UK. E-mail: P.Emery{at}leeds.ac.uk


  Abstract

Inflammation is the major factor driving the progression of structural damage in rheumatoid arthritis (RA); therefore, it is critical to achieve rapid suppression of inflammation to maximize disease control. The severity of inflammation and progression of joint damage varies from patient to patient. Some patients have the propensity to change slowly over time and then progress in a more rapid and dynamic fashion. In those where inflammation is more severe, extensive damage can occur within only a few years of disease onset. The progress of joint destruction, as assessed radiographically, results in a decline in functional capacity and quality of life. Consequently, the challenge for clinicians is to identify and treat those patients who develop rapid, progressive disease. Several biological markers and clinical indicators have been identified to help predict or establish which of the patients have rapidly progressing disease or who are at most risk for rapid progression. Early diagnosis of patients with rapidly progressing RA enables immediate and intensive intervention (e.g. with biologic therapy) and a greater opportunity to change the course of disease.

KEY WORDS: Biologic therapy, Disease progression, Inflammation, Rheumatoid arthritis

Submitted 15 May 2007; revised version accepted 8 August 2007.
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