Box 1. Information provided to delegates for anonymous comment: summaries of phases that individuals (may) pass through before the development of RA. Delegates were asked to provide descriptive terms for these phases and to comment on their chosen descriptive terms. ▶ Individual at risk of RA on the basis of genetic and environ- mental risk factors with no identiﬁable laboratory abnormali- ties and no symptoms or signs of inﬂammatory arthritis. ▶ Individual at risk of RA on the basis of laboratory abnormali- ties (eg, ACPA, RF positivity) with no symptoms or signs of inﬂammatory arthritis. ▶ Individual at risk of RA on the basis of symptoms of inﬂam- matory arthritis (eg, arthralgia/morning stiffness) but no clini- cal or imaging evidence of synovitis. ▶ Individual with synovitis on imaging but no clinically appar- ent inﬂammatory arthritis. ▶ Individual with clinically apparent inﬂammatory arthritis not yet fulﬁlling classiﬁcation criteria for RA. order to inform clinically relevant developments in outcome prediction and therapy. The initial remit of the study group was to agree on termi- nologies to be used during the preclinical and earliest clinically apparent phases of RA and to deﬁne important research ques- tions. This report describes this process and its conclusions. METHODS AND RESULTS Terminology for describing phases of RA To facilitate discussion about terminologies to be used in the phases of disease before individuals develop RA, a three-stage structured process was followed. Stage 1 Brief summaries of widely accepted phases that individu- als (may) pass through before the development of RA (box 1) were circulated to participants (19 key researchers in the ﬁeld; rheumatologists, basic scientists and a patient representative), who were asked to provide descriptive terms for these phases, and to comment on their chosen descriptive terms. Participants were asked to identify whether they felt that there were other phases that should be considered in the context of the develop- ment of descriptive terms. Terms that are currently widely used to describe individuals in phases before the development of RA (box 2) were circulated to participants who were asked to state whether they felt the terms were useful and to comment further on them. Fifteen responses were received for stage 1. Stage 2 Anonymised data from stage 1 were fed back to participants before a 2-day meeting. Stage 3 Eighteen of the participants met during a 2-day workshop. Anonymised responses from previous stages were presented and discussed at the meeting. The following key issues were discussed. First, there was extensive discussion about the terms ‘pre-RA’ and ‘preclinical RA’. It was felt that it was only appro- priate to use these in situations in which one knew that the ﬁnal Ann Rheum Dis 2012;71:638–641. doi:10.1136/annrheumdis-2011-200990 Recommendation outcome was RA and when one was looking backwards through the patient’s history describing particular phases the patient had gone through. In particular, there was consensus that the term ‘pre-RA’ suggested that the patient would deﬁnitely progress to RA; without a set of risk factors that were 100% speciﬁc it was felt that the term was inappropriate and, as highlighted by the patient representative, of concern to patients and their families if it was used as a shorthand for those individuals identiﬁed at high risk of RA. Second, there was consensus that the terminology used should be able to reﬂect that the different phases: do not occur in all patients who eventually develop RA (eg, some patients may never have evidence of autoantibodies associated with RA during the preclinical phase of disease); do not necessarily occur in the same order in all patients (eg, some patients may develop autoantibodies before the development of inﬂammatory joint symptoms and other patients may develop these after the devel- opment of such symptoms). Following these discussions a draft proposal for terminology was developed and this was further reﬁned. The ﬁnal consensus is shown in box 3. Recommendations for reporting of the phases of clinically apparent disease Currently there is a diversity of approaches to the dating of ‘onset’ in cohorts of patients with RA including from: the onset of any joint symptoms related to the current episode includ- ing arthralgia/morning stiffness; the onset of self-reported joint swelling; the onset of clinically observed swelling; the time of fulﬁlment of classiﬁcation criteria for RA. During the 2-day meeting, a consensus was reached that, as best practice, in prospective cohort studies the following dates are recorded: (1) First musculoskeletal symptoms relevant (in the opinion of the assessing rheumatologist) to the current complaint. (2) First persistent (ie, chronic until presentation) patient reported joint swelling. (3) Initial fulﬁlment of criteria for RA (1987 American College of Rheumatology (ACR)9 and 2010 ACR EULAR)10 based on data obtained retrospectively from the patient’s history. (4) Initial fulﬁlment of criteria for RA (1987 ACR and 2010 ACR EULAR) based on the rheumatologist’s assessment. It was recognised that it may not be feasible in all situations to collect all these data. However, it was felt that in all situations investigators should report clearly what they were using as their ‘starting point’ when reporting symptom/disease durations. Future research agenda During the 2-day meeting a number of areas were identiﬁed as being in need of urgent investigation: Identiﬁcation of additional risk factors and biomarkers and analysis of interactions between these as individuals progress through different phases of disease The need to identify additional risk factors and biomarkers for the development of RA was unanimously agreed. Each estab- lished and putative factor will have to be clearly deﬁned, in order to harmonise the classiﬁcation of individuals between cohorts, for example as a precise genotype rather than an allelic odd ratio for a genetic factor. A clear need was identi- ﬁed for an assessment of which phases these were risk factors/ biomarkers for. For example, a particular risk factor may be relevant only to progression to the development of systemic 639