Treatment of early rheumatoid arthritis

Rheumatoid arthritis is common and leads to joint damage due to persistent synovitis. Aggressive treatment within the first few years after symptom onset, with either disease-modifying antirheumatic drugs or antitumor necrosis factor therapy, reduces the rate of disease progression. There is increasing interest in the concept that the first few months after symptom onset represent a pathologically distinct phase of disease and that this translates into a therapeutic window of opportunity during which it may be possible to switch off the disease process. The rationale for, and difficulties associated with, treatment within this window are discussed.