[Rheumatoid arthritis: early detection may nip it in the bud]

The finding that IgM-rheumatoid factor and anti-cyclic citrullinated peptide were present in stored blood samples in a significant number of patients with rheumatoid arthritis years before the manifestation of the disease, suggests the disease has a long pre-clinical phase. It might thus be possible to prevent clinical disease by initiating treatment in this pre-clinical phase. Recently a Dutch clinical trial was started with this objective. Patients at risk will be randomised to receive dexamethasone or placebo treatment.