[Early diagnosis of rheumatoid arthritis]

The therapeutic concept of rheumatoid arthritis changed dramatically during the last years. There is significant evidence for the need of an early treatment with disease modifying drugs, the new therapeutic aim is remission. And then the question is: what is a rheumatoid arthritis and when does it start? There is move into the direction of an early undifferentiated arthritis, which may or may not become a persistent arthritis with or without development of erosions. Diagnostic criteria for rheumatoid arthritis are not exsisting, and this article comes after reviewing the existing instruments to the conclusion there is no need for such criteria. In fact, there is a need for instruments that evaluate the risk of an individual patient for persistence, erosive arthritis, and even better, the severity of the disease, which means a judgement of progression. And then the rheumatologists can set the crossbar for starting a DMARD-therapy.