Author Affiliations: National Institutes of Health, Bethesda, Md.
Grand Rounds at the Clinical Center of the National
Institutes of Health Section Editors: John I. Gallin, MD, the Clinical
Center of the National Institutes of Health, Bethesda, Md; David S. Cooper,
MD, Contributing Editor, JAMA.
Inflammatory synovitis of recent onset poses a diagnostic and prognostic
challenge to primary care physicians and rheumatologists. A lack of understanding
of the underlying etiologic and pathogenic processes limits the ability to
distinguish forms of arthritis that follow a benign, self-limiting course
from forms that proceed to an aggressive, erosive disease requiring intensive
immunosuppressive therapy. It is estimated that between 30% and 40% of patients
presenting with early synovitis have disease that remains unclassified. Using
data from a cohort of patients with early synovitis and reviewing current
literature, we discuss investigational approaches toward a new classification
of patients with early synovitis. Although a lack of understanding of this
heterogeneous clinical syndrome has led clinicians to take a largely empirical
approach to treatment thus far, the evolving awareness of disease predisposition
at a genetic level and the expanding ability to specifically manipulate biological
pathways may ultimately change the approach to this clinical problem.
El-Gabalawy HS, Duray P, Goldbach-Mansky R. Evaluating Patients With Arthritis of Recent OnsetStudies in Pathogenesis and Prognosis. JAMA. 2000;284(18):2368-2373. doi:10.1001/jama.284.18.2368