TY - JOUR T1 - Later Comes Earlier, Nowadays JF - The Journal of Rheumatology JO - J Rheumatol SP - 2287 LP - 2289 DO - 10.3899/jrheum.111130 VL - 38 IS - 11 AU - ELIZABETH C. ORTIZ AU - KARINA D. TORRALBA AU - JAMES R. O’DELL AU - RICHARD S. PANUSH Y1 - 2011/11/01 UR - http://www.jrheum.org/content/38/11/2287.abstract N2 - While we deliberate about beginning, it is already too late to begin. Quintilian, 35–96 BCEWe all agree that early identification and treatment of rheumatoid arthritis (RA) with “tight” control currently provide us our best opportunities to optimize outcomes for patients1,2,3,4,5,6,7,8,9,10,11. At present we seek drug-induced suppression of disease for prevention of inflammatory damage and consequent disability. We expect remissions in half or more patients we are able to treat early. We hope an occasional patient will retain a remission when drugs are tapered and even stopped. We are thrilled to have at least 9 conventional and 9 biological disease-modifying antirheumatic drugs (DMARD) to choose from and combine. However, we are frustrated that we do not have better markers to allow us to select the best therapy for each patient without the trial-and-error process we now utilize. We are disappointed and saddened when treatments fail, and patients suffer rather than benefit from therapy, as still happens. We struggle, too often unsuccessfully, to provide expensive state-of-the-art medications to all we think should receive them.Early recognition and intervention for RA is one of the triumphs of an age of rheumatology that has truly transformed how we think about caring for patients. There is now urgency in finding RA patients and getting them to rheumatologists or comparable therapeutic programs. We now have new criteria that facilitate early classification of RA12. The 2010 revised classification criteria provide a framework to identify patients before the progression of disease (by eliminating the requirement of at least 6 weeks of disease or presence of nodules or erosions, and by focusing on the … Address correspondence to Dr. Panush. E-mail: panush{at}usc.edu ER -