Sokka T, Pincus T
Vanderbilt University Medical Center, Nashville, TN, USA.
Clin Exp Rheumatol. 2003 Sep-Oct;21(5 Suppl 31):S5-14.
Research concerning early arthritis and early rheumatoid arthritis (RA) may be considered to have begun with population-based studies in the United Kingdom, the United States and Scandinavia, from the late 1950s to the late 1960s. These studies indicated that the majority of people with clinical findings of RA had no evidence of disease 3-5 years later, and that only about 25% to 30% of people in a population who met the criteria for RA had rheumatoid factor. These findings may have contributed to an underestimation of RA until the severity of long-term outcomes of clinical RA were recognized in the 1980s on the basis of clinical cohorts. The first major early RA clinical cohort was established in 1957-1963 in Bath, England. Although results at 3 and even 11 years were not overly unfavorable, by 15 and 20 years most patients had severe outcomes of functional declines and premature mortality. The Middle-sex (UK) early RA cohort established in 1966-1971 indicated that radiographic abnormalities were observed in about 70% of patients by 2 years of disease, and were seen in most patients initially in the feet. The Memphis (Tennessee, USA) early RA cohort established in 1967-1971 suggested that a progressive course of RA is predicted by a higher number of involved joints at baseline. The Lund (Sweden) early RA cohort established in 1985-1989 indicated rather severe long-term outcomes in patients treated according to traditional conservative approaches to use of disease modifying anti-rheumatic drugs (DMARDs). The early RA study (ERAS) involving nine National Health Service trusts in the UK was established in 1987-93, and showed associations of education level and socioeconomic status with clinical status. The movement towards early arthritis clinics was given great impetus following the work by Emery in the early 1990s. These studies and others described elsewhere in this supplement have contributed to the foundations for the clinical approach to early arthritis in the 21st century.
关于早期关节炎和早期类风湿关节炎（RA）的研究可追溯到20世纪50年代末至60年代末在英国、美国和斯堪的纳维亚开展的基于人群的研究。这些研究表明，大多数有RA临床症状的人在3至5年后并无疾病迹象，而且在符合RA标准的人群中，只有约25%至30%的人有类风湿因子。这些发现可能导致了对RA的低估，直到20世纪80年代基于临床队列认识到临床RA长期后果的严重性。第一个主要的早期RA临床队列于1957年至1963年在英国巴斯建立。尽管3年甚至11年的结果并非极其不利，但到15年和20年时，大多数患者出现了功能衰退和过早死亡的严重后果。1966年至1971年在英国米德尔塞克斯建立的早期RA队列表明，约70%的患者在患病2年时出现影像学异常，且大多数患者最初在足部出现。1967年至1971年在美国田纳西州孟菲斯建立的早期RA队列表明，基线时受累关节数量较多预示着RA病情呈进展性。1985年至1989年在瑞典隆德建立的早期RA队列表明，按照使用改善病情抗风湿药物（DMARDs）的传统保守方法治疗的患者长期后果相当严重。1987年至1993年在英国开展的涉及九个国民健康服务信托机构的早期RA研究（ERAS）表明，教育水平和社会经济地位与临床状况有关联。20世纪90年代初埃默里的研究工作极大地推动了早期关节炎诊所的发展。本增刊其他地方描述的这些研究及其他研究为21世纪早期关节炎的临床治疗奠定了基础。
