[Early diagnosis of rheumatoid arthritis: importance of ultrasonography]

Early diagnosis of rheumatoid arthritis needs collaboration between primary care doctors and rheumatologist. Three signs evoke this diagnostic more than three swollen joints; squeeze test positive for metacarpophalangeal and metatarsophalangeal and morning stiffness of >/= 30 minutes. The patient must be referred o rheumatologist for better assessment if there is one of this signs. The specific test as auto-antibodies to citrullinated proteins and joint ultrasonography are used for etiologies and retraining early rheumatoid arthritis diagnosis. Anti ccp are early positive and have a high specificity [99%]. The new generation tests with ELISA can give better sensibility [70%]. Osteoarticular ultrasonography can visualize synovitis, joint effusin, erosions in joints which are difficult to be assessed clinically. Also ultrasonography can visualize erosions and narrow joint space before radiological stade and synovitis activity with Doppler. It can also guide local intervention and assess evolution of rheumatoid arthritis under treatment. Early prescription of treatment can decrease and even stop articular destruction which is the principal factor of functional handicap in rheumatoid arthritis