CLINICAL PEARL Diagnosing Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a common, chronic autoimmune disease with high morbidity and mortality. RA prevalence is approximately 1 percent worldwide, with higher rates among Native Americans and lower rates in Asia and rural Africa. Twice as many women as men have the condition, and the mean age of those affected is 66 (incidence climbs beginning at age 40 and declines after 70). In recent years, the mean age has risen, and there has been a small decline in prevalence [1]. The disease is accompanied by chronic pain and functional impairments (with the resulting loss of productivity and disability) caused by varied degrees of joint destruction—until recently considered an inexorable consequence of the disease. Within the last few years, it has become apparent that the earlier the disease is diagnosed and the sooner the treatment with disease-modifying antirheumatic drugs (DMARDs) is started, the better the outcomes—there may be a “window of opportunity ” in which prompt recognition and treatment of RA can lead to sustained remission and prevent all or most structural joint damage [2, 3]. It is therefore important to be familiar with RA presentation. Until late last year