Palindromic Rheumatism: A Pre-Rheumatoid Arthritis State?

Rheumatoid arthritis (RA) is a chronic, autoimmune, inflammatory disease that can be debilitating if left untreated, and has demonstrated increased mortality1. With each passing year, the rheumatology community better understands how to effectively treat and manage these patients, and complete remission is possible. However, remission is often achieved using at least one, if not a combination of, disease-modifying agents, not to mention glucocorticoids, which many patients are initially resistant to, and which can cause significant side effects and have poor connotation. Over the last decade, rheumatologists have seen the importance of new treatment interventions, achieving improved outcomes for the RA patient community through more aggressive and earlier therapeutic management, as well as many new pharmacologic treatment options. Despite these important advances in the field, we still lack strong predictive measures for RA at most stages of disease. Which patients will respond better to which disease-modifying agents or biologics? Which patients are more likely to develop permanent bone changes? Who will most benefit from early intervention? Can we predict who will develop RA at all? Data are lacking on this last, …