advent of more effective RA treatments and more aggressive patient management strategies, drug free remission is now a possibility however, an important consideration when weaning a patient off of a DMARD is the concomitant risk of flaring. In a cohort of 331 patients from the EUPA cohort, Carrier et al. demonstrated that 14-3-3η positivity at the time of remission was associated with increased likelihood of radiographic progression. Whilst further research is required to investigate how 14-3-3η informs risk of flaring and radiographic progression in patients that have achieved remission, the current data indicates that patients in clinical remission with a positive 14-3-3η test should be considered as higher risk for disease progression. Detection of 14-3-3η Pre-Disease or in Other Arthritides. As earlier detection of RA is often associated with better clinical outcomes, evaluating how 14-3-3η informs risk of disease onset in asymptomatic patients is and will continue to be of paramount importance to investigate. In a study by Hitchon et al, the authors demonstrated that 14-3-3η levels were detectable in 1st degree relatives of patients diagnosed with RA, and that levels of 14-3-3η increased in 1st degree relatives at the time of transition to RA. The authors suggested that 14-3-3η was an imminent marker of RA transition. Additional studies in a larger subset of patients is required to fully evaluate when, why and how 14-3-3η levels increase in at-risk patients. 14-3-3η has also been demonstrated to be detectable in lupus patients diagnosed with secondary Sjogren’s, albeit at lower levels than RA patients. References Further reading External links Genes 14-3-3 proteins