Question
If you have joint stiffness and pain that is pretty limiting but only marginal chemistry profiles (elevated ESR-40 for male, slightly positive RF) should DMARDS be started or should there be more definitive criteria? Physical symptoms for over a year.
Answer
DMARDS should be started once the diagnosis of RA is secure which usually means persistent joint swelling and pain for more than 6 weeks. If you have absolutely no joint swelling, then you might want to wait before starting DMARDS. However in some cases, if the symptoms are severe and there is joint tenderness on exam, then use of a DMARD might be contemplated over time, particularly if the RF is positive.
