The outcome of treatment of patients with rheumatoid arthritis (RA) has qualitatively improved in recent years due to better and earlier treatment approaches, and new drugs. It is now generally accepted that the phenotype of RA is the end-point of a disease continuum. Large retrospective studies have identified anti-citrullinated protein antibodies (ACPAs) and rheumatoid factor in the stored serum of patients, years before the development of clinical RA. Recent data suggest mucosal sites such as the oral mucosa (in particular the periodontium), lung and gut may be the sites where auto-immunity is initiated. The role of bacteria at these sites is reviewed. Much recent work has focussed on the role of high resolution imaging namely ultrasound and magnetic resonance imaging in identifying subclinical inflammation in at-risk individuals with early musculoskeletal symptoms (e.g. arthralgia) but without clinical synovitis. Importantly, the first musculoskeletal site involved is usually not the joint (synovium). Sub-clinical disease predicts the onset of clinical arthritis, and its timing, in symptomatic at-risk individuals. These and other predictive markers will be described. The ability to identify patients at-risk of RA before joint involvement has led to interventions aimed at preventing/delaying disease. Once arthritis occurs, rapid remission is the target of therapy. The percentage of patients with RA achieving clinical remission has improved markedly compared with a few decades ago. The optimum outcome is to induce remission sufficiently profound so that therapy can be stopped, without flare, that is drug-free remission, which is effectively cure. Limitations of the tools used to measure remission, the outcome of tapering therapy, and new approaches to achieve successful drug cessation are described. Overall, this article reviews progress towards meeting the unmet needs of prevention/cure.

中文翻译：

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预防和治疗：类风湿性关节炎的主要未满足需求。

近年来，由于更好、更早的治疗方法和新药的出现，类风湿性关节炎 (RA) 患者的治疗结果有了质的改善。现在普遍认为 RA 的表型是疾病连续体的终点。大型回顾性研究已经在临床 RA 发生前数年发现患者储存的血清中存在抗瓜氨酸蛋白抗体 (ACPA) 和类风湿因子。最近的数据表明，口腔黏膜（特别是牙周组织）、肺和肠道等黏膜部位可能是启动自身免疫的部位。回顾了细菌在这些部位的作用。最近的许多工作都集中在高分辨率成像的作用上，即超声和磁共振成像在识别具有早期肌肉骨骼症状（例如关节痛）但没有临床滑膜炎的高危个体的亚临床炎症方面的作用。重要的是，第一个涉及的肌肉骨骼部位通常不是关节（滑膜）。亚临床疾病可预测有症状的高危个体临床关节炎的发作及其时间。将描述这些和其他预测标记。在关节受累之前识别有 RA 风险的患者的能力导致了旨在预防/延迟疾病的干预措施。一旦发生关节炎，快速缓解是治疗的目标。与几十年前相比，达到临床缓解的 RA 患者的百分比显着提高。最佳结果是诱导足够深度的缓解，从而可以停止治疗而不会出现复发，即无药物缓解，即有效治愈。描述了用于衡量缓解的工具的局限性、逐渐减量治疗的结果以及实现成功戒毒的新方法。总体而言，本文回顾了在满足未满足的预防/治疗需求方面取得的进展。