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Rheum Dis Clin North Am. 2014 Nov;40(4):569-80. doi: 10.1016/j.rdc.2014.07.001. Epub 2014 Sep 2.

Preclinical inflammatory rheumatic diseases: an overview and relevant nomenclature.

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School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK; Department of Rheumatology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham B18 7QH, UK. Electronic address:
Academic Medical Center, Division of Clinical Immunology & Rheumatology F4-105, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; Clinical Unit Cambridge, GlaxoSmithKline, Addenbrooke's Centre for Clinical Investigation, Box 128, Hills Road, Cambridge CB2 0GG, UK.


Chronic inflammatory and autoimmune conditions result from an interplay between genetic and environmental factors culminating in the phenotypes of established disease. The transition from health to established disease is relatively well understood in rheumatoid arthritis (RA), which provides an exemplar for other diseases. This article addresses terminologies to describe the phases of disease leading to RA, disease initiation and the point from which disease duration should be timed, the future research agenda suggested by this approach to the definition of phases of disease, and the importance of capturing the patient perspective in research into the earliest phases of disease.


Early; Preclinical; Prediction; Prevention; Rheumatoid arthritis; Risk

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