TY - JOUR T1 - How Are Rheumatologists Managing Anticyclic Citrullinated Peptide Antibodies–positive Patients Who Do Not Have Arthritis? JF - The Journal of Rheumatology JO - J Rheumatol SP - 305 LP - 306 DO - 10.3899/jrheum.190211 VL - 47 IS - 2 AU - KULVEER MANKIA AU - CHRISTOPHER BRIGGS AU - PAUL EMERY Y1 - 2020/02/01 UR - http://www.jrheum.org/content/47/2/305.abstract N2 - To the Editor:Early referral and initiation of disease-modifying antirheumatic drugs (DMARD) is associated with better outcomes for patients with rheumatoid arthritis (RA)1,2. In the United Kingdom, general practitioners (GP) are advised to refer patients with suspected RA urgently3 and rheumatology departments are rewarded for timely management of these patients4.Although a positive step, a corollary of this is that rheumatologists are now seeing patients earlier in the natural history of RA [e.g., patients with autoantibodies, especially anticyclic citrullinated peptide antibodies (anti-CCP) and symptoms but no clinical synovitis, who are at risk of developing RA]. This presents a clinical problem but also a significant opportunity. There is no evidence for the management of these (often symptomatic) at-risk individuals, but it is possible that the right intervention in this phase may prevent clinical arthritis5,6. This hypothesis is being explored in clinical trials (e.g., rituximab delayed, but did not prevent, arthritis onset in at-risk individuals)7. We were interested in … Address correspondence to Dr. K. Mankia, Academic Clinical Lecturer in Rheumatology, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK. E-mail: k.s.mankia{at}leeds.ac.uk ER -