How to Detect Early Stage Rheumatoid Arthritis (RA) in Persons Undergoing Ningen Dock (Health Evaluation and Promotion)

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Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease. It is most frequently seen in rheumatic diseases. Recent advances in the treatment of RA can prevent bone/cartilage destruction and improve the prognosis of RA patients. In view of this situation, the concept of “T2T”, “Treatment to target”, has been established to administer appropriate treatment, such as that with methotrexate and newly developed biological agents, which will attain clinical remission as well as radiographic and functional remission. Such biological agents have direct effects against pro-inflammatory cytokines such as TNF-α and IL-6 in RA synovial tissues. Smoking is a risk factor for RA in association with genetic factors. Although morning stiffness is not specific to RA, joint swelling and/or tenderness reflects synovitis and is an important clinical feature. Pulmonary involvement should be investigated as an extra-articular manifestation. Laboratory examinations, which include acute-phase reactants such as CRP and erythrocyte sedimentation rate (ESR), evaluate disease activity. IgM RF is also tested as a diagnostic tool, although it is also detected in other diseases. Anti-citrullinated protein antibodies (ACPA) are a new marker for the diagnosis of RA and predict articular destruction. It is necessary to obtain a definite diagnosis through classification in order to start suitable treatment for RA patients in the early stage. As the previously published American College of Rheumatology (ACR) 1987 revised criteria were not useful for identifying RA patients in the early stage, the ACR and European League against Rheumatism (EULAR) proposed new criteria for the classification of RA in 2010.