Abstract
The terms early arthritis, undifferentiated arthritis (UA) and early rheumatoid arthritis
(RA) are not completely synonymous. They refer to slightly different sets of patients
with intrinsic differences in the disease outcome. UA refers to arthritis that cannot
be classified according to current criteria. The disease course of UA is variable,
40–50% remit spontaneously, whereas about one third of the UA-patients are in an early
phase of RA. These UA-patients provide an opportunity, as the disease process in UA
is less established and treatment in this early phase may halt the progression towards
RA. To identify the UA-patients who will develop RA a prediction rule has recently
been developed. This rule estimates the chance to develop RA in individual UA-patients
and its predictive ability is established in several countries throughout the world.
Another initiative to identify RA patients early is the development of new classification
criteria for RA. The sensitivity and specificity for early RA of these criteria are
not known yet. Clinical trials evaluating the effects of DMARD-therapy in UA are still
scarce but are needed in order to derive a personalized medicine for UA-patients.
Zusammenfassung
Die Begriffe Früharthritis, undifferenzierte Arthritis (UA) und frühe rheumatoide
Arthritis (RA) sind nicht vollständig synonym zu gebrauchen. Vielmehr beschreiben
sie verschiedene Patientensubgruppen mit spezifischen Unterschieden des Krankheitsverlaufes.
UA bezeichnet eine Arthritis, die gemäß aktueller Kriterien nicht klassifiziert werden
kann. Der Krankheitsverlauf ist variabel, 40–50% remittieren spontan, während ein
Drittel der UA Patienten sich bereits in einem Frühstadium einer RA befindet. Bei
diesen UA Patienten besteht die Chance, durch entsprechende Behandlung in dieser frühen
Phase die Progression in Richtung RA aufzuhalten, da der Krankheitsprozess zu diesem
Zeitpunkt noch weniger etabliert ist. Um Patienten zu identifizieren, die eine RA
entwickeln werden, wurde kürzlich ein Vorhersage Score entwickelt. Dieser Score ermöglicht
eine Risikoabschätzung für den individuellen UA Patienten für die Entwicklung einer
RA. Der prädiktive Wert dieses Scores ist in zahlreichen Ländern weltweit etabliert.
Eine weitere Möglichkeit zur frühen Identifikation von RA Patienten ist die Entwicklung
neuer Klassifikationskriterien für die RA. Die Sensitivität und die Spezifität für
diese Kriterien sind bisher nicht erforscht. Es liegen nur wenige klinische Studien
zur Bewertung der Wirksamkeit der DMARD-Therapie bei UA vor. Solche Untersuchungen
werden aber dringend benötigt, um UA Patienten eine spezifische Medikation bieten
zu können.
Key words
early arthritis - prognosis - rheumatoid arthritis
Schlüsselwörter
Früharthritis - Prognose - Rheumatoide Arthritis
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Correspondence
Dr. Annette van der Helm-vanMil
LUMC Rheumatology
PO Box 9600
2300 RC Leiden
Netherlands
Phone: +31/71/5263598
Fax: +31/71/5263598
Email: A.H.M.van_der_Helm@lumc.nl
