Commentary What can we learn from the synovium in early rheumatoid arthritis

Rheumatoid arthritis (RA) affects approximately 1% of the population and is a chronic inflammatory joint dis- ease resulting in joint destruction, increased morbidity and mortality (1). Although the aetiology of this disease is unknown, the pivotal role played by cytokines and degrada- tive enzymes in mediating inflammation and joint destruc- tion, particularly early in the disease process, has been the focus of recent literature and will be the focus of this review. Up until recently, studies on early RA were limited as there was an inherent delay in patients reaching the rheumatolo- gist's care and initial diagnostic confusion may have com- pounded these problems. In particular, the observation that early intervention improves outcome, has driven the study of early RA. It is difficult to define early RA but most studies have defined this as disease duration of less than 12 months from symptom onset. Clearly, it is important to study the syn- ovial membrane in early disease, in particular to try and answer the important questions: