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The Importance of Early Arthritis in Patients with Rheumatoid Arthritis Georgiana Iftimie Clinical Emergency Hospital of Bucharest, Bucharest, Romania

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The Importance of Early Arthritis in Patients with Rheumatoid Arthritis Georgiana Iftimie Clinical Emergency Hospital of Bucharest, Bucharest, Romania Journal of Mind and Medical Sciences Volume 5 | Issue 2 Article 6 2018 The importance of early arthritis in patients with rheumatoid arthritis Georgiana Iftimie Clinical Emergency Hospital of Bucharest, Bucharest, Romania Ana Maria Alexandra Stanescu Carol Davila University of Medicine and Pharmacy, Bucharest, Romania Mihaela A. Iancu Carol Davila University of Medicine and Pharmacy, Bucharest, Romania Anca Pantea Stoian Carol Davila University of Medicine and Pharmacy, Bucharest, Romania Razvan Hainarosie Carol Davila University of Medicine and Pharmacy, Prof. Dr. D. Hociota Institute of Phonoaudiology and Functional ENT Surgery, Bucharest, Romania See next page for additional authors Follow this and additional works at: https://scholar.valpo.edu/jmms Part of the Immune System Diseases Commons, Rheumatology Commons, and the Skin and Connective Tissue Diseases Commons Recommended Citation Iftimie, Georgiana; Stanescu, Ana Maria Alexandra; Iancu, Mihaela A.; Pantea Stoian, Anca; Hainarosie, Razvan; Socea, Bogdan; Isvoranu, Gheorghita; Marcu, Dragos; Neagu, Tiberiu P.; and Diaconu, Camelia C. (2018) "The importance of early arthritis in patients with rheumatoid arthritis," Journal of Mind and Medical Sciences: Vol. 5 : Iss. 2 , Article 6. DOI: 10.22543/7674.52.P176183 Available at: https://scholar.valpo.edu/jmms/vol5/iss2/6 This Review Article is brought to you for free and open access by ValpoScholar. It has been accepted for inclusion in Journal of Mind and Medical Sciences by an authorized administrator of ValpoScholar. For more information, please contact a ValpoScholar staff member at [email protected]. The importance of early arthritis in patients with rheumatoid arthritis Cover Page Footnote none Authors Georgiana Iftimie, Ana Maria Alexandra Stanescu, Mihaela A. Iancu, Anca Pantea Stoian, Razvan Hainarosie, Bogdan Socea, Gheorghita Isvoranu, Dragos Marcu, Tiberiu P. Neagu, and Camelia C. Diaconu This review article is available in Journal of Mind and Medical Sciences: https://scholar.valpo.edu/jmms/vol5/iss2/6 J Mind Med Sci. 2018; 5(2): 176-183 doi: 10.22543/7674.52.P176183 Review The importance of early arthritis in patients with rheumatoid arthritis Georgiana Iftimie1, Ana Maria Alexandra Stănescu2, Mihaela Adela Iancu2, Anca Pantea Stoian2, Răzvan Hainăroșie2,3, Bogdan Socea2,4, Gheorghița Isvoranu5, Dragoș Marcu2,6, Tiberiu Paul Neagu1,2, Camelia C. Diaconu1,2 1 Clinical Emergency Hospital of Bucharest, Bucharest, Romania 2Carol Davila University of Medicine and Pharmacy, Bucharest, Romania 3Prof. Dr. D. Hociota Institute of Phonoaudiology and Functional ENT Surgery, Bucharest, Romania 4St. Pantelimon Emergency Hospital, Department of surgery, Bucharest, Romania 5Victor Babes National Institute of Pathology, Bucharest, Romania 6 Emergency University Central Military Hospital, Bucharest, Romania Abstract Rheumatoid arthritis (RA) is a systemic inflammatory disorder that manifests predominantly in the synovial joint, where it causes a chronic inflammatory process, leading to early osteoarticular destructions. These destructions are progressive and irreversible, generating a significant functional deficiency. During the last years, the diagnostic approach of RA has focused on early arthritis. Early arthritis can develop into established RA or another established arthropathy, like systemic lupus erythematosus or psoriatic arthritis. It can have a spontaneous resolution or may remain undifferentiated for indefinite periods of time. The management of early arthritis has changed considerably in the past few years, under the influence of new concepts of diagnosis and new effective therapies. The treatment goal of early arthritis should now be the clinical remission and prevention of joint destruction. Methotrexate is the first line of therapy, used to treat early arthralgia and to reverse or limit impending exacerbation to RA. Biological treatment is used as a second line therapy in patients with severe disease who do not respond or have a contraindication to disease-modifying antirheumatic drugs (DMARDs). Patients with early arthritis should usually be identified and directed to rheumatologists to confirm the presence of arthritis, and to establish the correct diagnosis plus to initiate the proper treatment strategies. Keywords early arthritis, rheumatoid arthritis, DMARDs, anticarbamilated protein antibodies. Highlights ✓ Patients with early arthritis should be referred to the rheumatologist, to be able to establish a fast diagnosis and prompt therapy. ✓ The management of early arthritis should include not only drug treatment but also specific medical education. To cite this article: Iftimie G, Stănescu AM, Iancu MA, Stoian AP, Hainăroșie R, Socea B, Isvoranu G, Marcu D, Neagu TP, Diaconu CC. The importance of early arthritis in patients with rheumatoid arthritis. J Mind Med Sci. 2018; 5(2): 176-183. DOI: 10.22543/7674.52.P176183 *Corresponding author: Camelia Diaconu, Carol Davila University/ Clinical Emergency Hospital of Bucharest, Romania E-mail: [email protected] Georgiana Iftimie et al. Introduction hormonal factors), environmental factors (smoking, infections - Porphyromonas gingivalis, Ebstein Barr Rheumatoid arthritis (RA) is a systemic virus, Mycoplasma pneumoniae), obesity, or socio- inflammatory disorder that manifests predominantly in economic status (5). the synovial joint, where it causes a chronic inflammatory process, leading to osteoarticular The evolutive phases of rheumatoid arthritis are destructions. These destructions occur early and are influenced by the presence of the risk factors: genetics progressive and irreversible, generating a significant (HLA-DRB1, PTPN22, STAT4, PAD14), smoking or bacteria like Porfiromonas gingivalis or Porfiromonas functional deficiency. RA is frequently accompanied by significant and varied systemic manifestations and could copri (6). reduce life expectancy due to several complications. These factors can precede the pre-clinical RA is the most common inflammatory rheumatic rheumatoid arthritis phase (no symptoms), which illness. The articular and systemic consequences have a involves the systemic autoimmunity, with high levels of significant impact on patients’ quality of life and rheumatoid factor, proinflammatory cytokines, high prognosis, but also on the healthcare systems. The sensitive C-reactive protein (CRP), and the positivity of disease has considerable heterogeneity and can have anti-citrullinated protein antibodies (ACPA) and anti- different forms: mild, non-erosive, sometimes with protein carbamylated antibodies (7). spontaneous remission, or severe, rapidly progressive Clinical manifestations forms, with significant and irreversible osteoarticular The early rheumatoid arthritis phase involves destructions. nonspecific signs and symptoms, including articular For a better prognosis of patients with RA, ones. The definite rheumatoid arthritis phase fulfills the establishing an earlier diagnosis and initiating treatment classification criteria, with systematic and articular is critical. In clinical practice, diagnosis of early arthritis manifestations, high inflammatory markers such as C- has become an important step. During the last years, the reactive protein (CRP) or erythrocyte sedimentation rate diagnostic approach of RA is focused on early arthritis. (ESR), high rheumatoid factor, and positive anti- Inflammatory arthritis is one of the most common citrullinated protein antibodies (ACPA) (8). pathological findings in clinical rheumatology. The diagnosis is based on the European League Identifying the main disease can be very difficult, Against Rheumatism (EULAR) defined characteristics, especially in an early stage. In clinical practice, an early patients with arthralgia being at risk for RA (9). These inflammatory arthritis is often undifferentiated (1). parameters are used in patients with arthralgia without Early arthritis can often lead to established RA or other clinical arthritis and without other diagnosis or other arthropathies, such as systemic lupus erythematosus or explanation for the arthralgia. The diagnosis of RA psoriatic arthritis. involves a history of joint symptoms with recent onset Most of the symptoms in early arthritis remain (duration less than 1 year) (10); symptoms localized in undifferentiated for indefinite periods of time. For a metacarpo-phalangeal joints; duration of morning better evaluation of the diagnosis of arthritis, stiffness more than 60 minutes; most severe symptoms recognizing the inflammatory arthritis is necessary. The present more in the early morning than the rest of the next step is to search for a definite diagnosis and to day; presence of a first degree relative with RA; first estimate the risk of developing persistent arthritis. An movement difficulties; and positive squeeze test of optimal therapeutic strategy is essential (2, 3). Although metacarpophalangeal joints (11). the prognosis of early arthritis is still difficult to assess, The undefined arthritis is approached differently by a combination of clinical, laboratory, and radiological two important rheumatology groups’ associations: the findings may help to predict patients’ outcomes. Norfolk group defines it as two or more swollen joints, Discussions for no less than two weeks, and the Leiden group sees it as one or more swollen joints, diagnosed by a Etiology rheumatologist, that have no other cause (12, 13). Numerous factors influence the onset of RA, the Regarding the symptoms, there is a series of majority being common with those
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