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 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...