The epidemiology of musculoskeletal inflammation

Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by progressive joint destruction often resulting in functional disability and increased mortality. With appropriate therapies, it is possible to delay or even prevent evolution of patients into RA and/or induce remission. Thus the identification of individuals not only early in the disease course but at risk of developing RA is important. Following on this concept, we investigated the presence of systemic autoimmunity among individuals at risk of RA based on environmental exposures, and conducted a meta-analyses showing an early therapeutic window of opportunity associated with sustained benefit on disease progression and structural damage. Since time matters, we examined both the recent criteria performance and the role of musculoskeletal ultrasound as tools to identify RA early in the disease course. One of the therapeutic goals in RA is the prevention of radiologically evident joint destruction, thus we evaluated a novel scoring method to assess radiological disease progression. We also examined the impact of inflammation on RA-associated collateral damage, including cardiovascular disease and bone loss. We observed within the epidemiology of musculoskeletal involvement that chronic inflammation in any one tissue clearly impacts the overall health status and disease susceptibility of the whole body.