hould We Use Poor Prognosis Factors to Start Early Treatment in Patients ith Rheumatoid Arthritis?

Treatment of rheumatoid arthritis (RA) has undergone a radical hange in recent years by optimization not only of classical treatents with disease modifying drugs and the introduction of new iological therapies,1–8 but also of the objectives (treat to target) n the shortand long-terms in monitoring and standardization of atients and procedures.9 It is increasingly evident that there is a window of opporunity period in which, after the diagnosis, the use of more ffective therapies and established pretreatment objectives lead o improved long-term prognosis.9,10 In this sense, the proposed ew referral and classification11 criteria for RA12 allow this therpeutic approach to be started early. Studies show that in the rst two years of treatment any well-considered strategy may nduce remission.13,14 What is more controversial is whether ong-term strategies based on non-biological agents compared o early introduction of biological drugs, maintain a prolonged emission avoiding further progression of radiologic damage15,16 r disability.17 In this regard, results from trials using biological nti-TNF-alpha drugs in patients with RA cohorts of established A patients show that active treatment and early introduction of iologic therapies are critical to the achievement of long term therpeutic objectives.18–21 The reality in our clinical practice is that despite the biologial treatment, a proportion of patients with inflammatory activity ersist or present radiological progression.22 The question remains hether therapy may be optimized in these patients. Recent pubications such as Aletaha et al.23 warn about the importance of the ersistence of swollen joints, rather than high values of C-reactive rotein (CRP) as a determinant of long-term radiographic progresion. It has shownadirect relationship between increases inDAS28,