[Early prediction of joint destruction in rheumatoid arthritis]

It is proposed by hypothesis that early intervention in rheumatoid arthritis might result in remission or cure. It was undertaken to classify rheumatoid arthritis (RA) in early stage from undifferentiated arthritis (UA) and predict the progression of joint destruction at the first visit using by serological markers and magnetic resonance imaging (MRI) . Logistic regression analysis using the statistical analysis system software demonstrated that the presence of anti-cyclic citrullinated peptide (CCP) antibody and/or immunoglobulin M-rheumatoid factor (IgM-RF) , symmetric synovitis and bone marrow edema and/or bone erosion at entry could discriminate patients with RA from UA or other than RA. A total score of two or more of the three objective measures allowed the prediction for RA with 83% sensitivity and 85% specificity, respectively. The presence of bone marrow edema and/or bone erosion determined by MRI is a forerunner of bone erosion on plain radiography. Both presences of anti-CCP antibody and/or IgM-RF and bone marrow edema determined by MRI may predict the early-stage of RA and the progression of articular destruction. From the above findings, it was recommended that early intervention of anti-rheumatic drugs and/or TNF blocker should be started the UA patients with both autoantibody (anti-CCP antibody and/or IgM-RF) and bone marrow edema determined by MRI.