Predictive markers in rapidly progressing rheumatoid arthritis.

The emphasis in rheumatoid arthritis (RA) management today is on early diagnosis and intervention, but the choice of intervention has become increasingly complex. The number of disease modifying antirheumatic drugs available for treatment of RA has increased significantly. The efficacy, toxicity, and cost of those agents vary widely. And the progression of joint damage in RA is highly unpredictable and variable, ranging from self-limited disease to rapid progressive destruction. Prognostic markers that could identify patients with aggressive, rapidly progressing disease and predict the response to therapy would provide a rational basis for early, aggressive treatment. They would also protect patients with less aggressive disease from possible overtreatment and toxicities, and could have a significant influence on allocation of healthcare resources. The search for predictive markers of arthritis outcome has been and undoubtedly will continue to be the subject of many studies. This article will review both established and emerging predictive markers in RA.