Rheumatoid arthritis (RA) is an autoimmune disease characterized by joint destruction, which leads to functional decline and disability as well as increased mortality (1-4). A growing body of evidence indicates that joint destruction and functional decline are improved by early therapeutic intervention (5,6). In addition, the risk of mortality is decreased in patients with RA who present early in the disease course, strongly suggesting that earlier diagnosis and treatment may have substantial long-term benefits (7). Because asymptomatic synovitis has been identified prior to major clinical manifestations of RA (8,9), prevention of disability in RA might be even more successful if interruption of the process underlying joint destruction were carried out in the early phase of the disease or even before the disease is clinically evident, rather than when destructive synovitis is well established.
The article by Rantapa Β¨a Β¨-Dahlqvist et al published in this issue of Arthritis & Rheumatism (10) demonstrates that antibodies to cyclic citrullinated peptide (CCP) as well as rheumatoid factor (RF) can be identified in stored serum from individuals who later develop clinically apparent RA. The authors conclude that such autoantibodies may be predictive of the future development of RA in asymptomatic individuals. This article raises the question of whether we can accurately identify