What is your approach to monitoring patients referred for high titer +RF and +CCP but without active symptoms of inflammatory arthritis?  

It has been well described that patients with a +RF and + CCP autoantibody may develop clinically active RA up to two decades or more (potentially lifelong) after the detection of these autoantibodies in a patient. It is now thought that there is a preclinical phase of autoimmune diseases including ...

I would not base my decision to treat or not to treat on X-rays and elevated titers; I would base it on the patient's symptoms and exam, as well as ultrasound findings (i.e., presence of subclinical synovitis). I would do more frequent ultrasound screening exams (every three (3) to six (6) months) g...

I agree with Dr. @Ware's detailed answer. I'd also suggest that, in a patient with arthralgias that are not particularly suspicious for inflammatory arthritis, early US may help to identify people who may warrant early therapy. However, more data is still needed before we can know which treatment is...

I agree with previous responses. The National Institutes of Health (NIH) sponsored the "Strategy to Prevent the Onset of Clinically-Apparent Rheumatoid Arthritis" (StopRA) trial, a randomized, double-blind, placebo-controlled study aimed at evaluating whether hydroxychloroquine (HCQ) could prevent ...

In my clinical experience, it is not critical that we start a DMARD unless there is clear evidence of synovitis. Subjective symptoms can persist for years before any overt signs of RA develop, or the disease may never develop. Smokers with CCP antibodies do have a higher chance of evolving into act...