I. New criteria for diagnostic classification The previous classification criteria for rheumatoid arthritis (RA) cannot achieve early diagnosis, and the classification criteria are not equal to the diagnostic criteria, so a reliable or true criteria for disease remission is needed. Remission includes the following: ① clinical remission meeting the American College of Rheumatology (ACR) Disease Activity Scale (DAS) score criteria, normal sedimentation (ESR) and C-reactive protein (CRP) or no clinical synovitis; ② imaging remission sensitive imaging methods such as magnetic resonance imaging (MRI) showing no significant synovitis and bone destruction; ③ true remission clinical remission and imaging remission. The new classification criteria for RA were introduced at this meeting. The new criteria determine that those who may develop persistent or destructive arthritis are classified as RA. The latest therapeutic research progress Tumor necrosis factor (TNF) antagonists are ineffective in 30% to 40% of RA patients. British scholars have confirmed that a gene locus is associated with response to TNF antagonist therapy, but the prediction rate is only 25%, and more predictive genes have to be identified. A Norwegian meta-analysis comparing the clinical data of leflunomide (244 cases) and MTX (288 cases) in combination with TNF antagonists for the treatment of RA found that the efficacy and adverse effects were similar at the 12th week of treatment. adverse effects were similar. A study called SWEFOT included patients with RA who met the following criteria: (i) disease duration <1 year; (ii) disease activity score of 28 joints (DAS28) >3.2; and (iii) no previous use of palliative antirheumatic drugs (DMARD). Patients were randomized to MTX + salazosulfapyridine (SSZ) + hydroxychloroquine (HCQ) (n=30) or MTX + TNF antagonist (n=128) for 12 months after 3-4 months of treatment with MTX (10-20 mg once weekly) for DAS28>3.2. The primary endpoint of the study was the number of patients who achieved a good response according to the European League Against Rheumatism (EULAR) criteria. Only 30% of patients with early RA responded to MTX alone (DAS <3.2); 25% of patients in the MTX+SSZ+HCQ group and 39% of patients in the MTX+TNF antagonist group achieved a good response to EULAR. Compared with the MTX+SSZ+HCQ group, the MTX+TNF antagonist group had a lower incidence of hematocrit reduction (5% versus 1%) and gastrointestinal reactions (15% versus 1%) and a higher incidence of infection (0 versus 11%). Third, factors affecting prognosis Disease remission is the immediate goal of RA treatment, and bone destruction still progresses in those who achieve clinical remission. In the United States, 115 serologically positive patients with early and rapidly progressive RA were treated with a combination of MTX, etanercept, HCQ and SSZ. At 2-year follow-up, it was found that 80% of patients had no pain and swelling in the wrist joint, half of them had moderate remission, and some of them reached clinical remission with DAS28. The time to clinical remission was not related to low MRI scores, and synovitis, tendonitis and bone edema were still visible on MRI in those who reached clinical remission with DAS28. A 10-year retrospective study in Greece included 144 patients with RA and recorded hand and wrist radiographic changes at baseline, year 5, and year 10 using Larsen scoring criteria. The results were a significant decrease in DAS28 with a corresponding decrease in acute protein response at each time point, but a progressive increase in Larsen score and number of joints destroyed, with only 12.5% of patients free of bone destruction at year 10. Univariate analysis showed that the Larsen score at year 10 was associated with baseline radiological changes, positive rheumatoid factor (RF) or anti-cyclic citrullinated peptide (CCP) antibodies, and disease duration; logistic regression analysis showed that the Larsen score was associated only with baseline radiological changes and positive RF or anti-CCP antibodies. This study confirmed that radiological changes progressed slowly despite clinical improvement and that baseline radiological changes and autoantibodies were the main predictors of poor radiological prognosis. The COBRA trial in the Netherlands included 115 patients with early, active and untreated RA and confirmed after 11 years of follow-up that baseline serum cytokine κB receptor activator ligand/protectin ratio (RANKL/OPG) was an independent predictor of progression of bone destruction.