[Management of patients with rheumatoid arthritis].

Recent years have shown considerable advances in the understanding of pathophysiology and clinical course of patients with rheumatoid arthritis. We now know that there is preclinical disease. Autoantibodies precede clinical symptoms and erosive disease can be seen in patients as early as at the beginning of the symptoms. Clinical progress has come from a better recognition of the natural history of disease. Outcome measures were developed and validated, allowing innovative trial design. Therapy must aim at achieving clinical remission, reversal from destructive to nondestructive arthritis and even healing of erosions. Such aim necessitates early diagnosis of disease and aggressive treatment. Regular assessment of the disease state should be performed. For disease assessment validated tools should be used. The search for new therapies is ongoing. Studies indicate there is a considerable window of opportunity in very early rheumatoid arthritis. If we can use this window of opportunity with an efficient therapeutic strategy we should be able to change the course of disease or even achieve long term remission.