Principles of Treatment
- Rheumatoid Arthritis (RA) is a chronic, inflammatory arthritis of unknown etiology
- Also considered an autoimmune rheumatic disorder; most common form of inflammatory arthritis
- Persistent synovitis leads to joint destruction & deformity
- Signs & symptoms include joint pain & swelling, morning stiffness lasting >1 hr, myalgia, weight loss, & low-grade fever
- Onset of signs and symptoms is < 6 mnths from time of diagnosis
- Onset of signs and symptoms is > 6 mnths from time of diagnosis & meets the classification criteria for RA
- Follows an episodic pattern
- Joints may be affected for hr to days followed by symptom-free periods lasting for days to mth
- May indicate onset of a polyarticular disease
- Interval between monoarthritis & polyarthritis may extend from days to wk in patients w/ progressive disease
- Large joints are frequently affected (eg shoulder, wrist, hip, knee, ankles)
- History of joint trauma may be the initiating event
- Anemia, fatigue, pleuropericarditis, neuropathy, scleritis, Sjogren’s syndrome, vasculitis
- Subcutaneous rheumatoid nodules on extensor surfaces of elbows & over Achilles tendons
- Splenomegaly, renal disease
Refer to Symptoms for more information on Rheumatoid Arthritis
Classification of rheumatoid arthritis is based on the criteria developed by the American College of Rheumatology (ACR) Board of Directors & European League Against Rheumatism (EULAR) Executive Committee, depending on the following points:
- Number and site of involved joints
- Serological abnormality
- Acute-phase reactants abnormality
- Symptom duration
Diagnosis is based on clinical signs & symptoms, lab results & imaging features
Laboratory tests used to diagnose rheumatoid arthritis include:
- Rheumatoid factor (RF)
- Anti-citrullinated protein antibody (ACPA)
- Acute phase reactants
- Complete blood count
- Synovial fluid analysis
Imaging studies used to confirm the diagnosis of rheumatoid arthritis include x-ray, MRI and ultrasound
Refer to Diagnosis for more information
- Management of rheumatoid arthritis aims for control of signs & symptoms, limit radiographic damage, & reduce functional limitations & permanent joint damage
- Therapeutic agents used for the management of rheumatoid arthritis depends on the severity of the disease
- Therapeutic options include non-biological DMARDs (gold salts, Hydroxychloroquine, Chloroquine, Leflunomide, Methotrexate, Sulfasalazine) & biological DMARDs (TNF inhibitors, non-TNF biologicals)
- TNF inhibitors used for rheumatoid arthritis include Adalimumab, Certolizumab pegol, Etanercept, Infliximab, Golimumab
- Non-TNF biologicals used for rheumatoid arthritis include Abatacept, Rituximab, Tocilizumab, Tofacitinib
- Combination therapy with DMARDs is considered as first-line treatment
- Adjunctive agents that may be used to manage symptoms of rheumatoid arthritis include analgesics, corticosteroids, & NSAIDs
- Exercise, physical therapy, occupational therapy, nutritional therapy & weight management, & splints may be considered
Refer to Non-pharmacological Therapy for information on Non-pharmacological Therapy
Refer to Pharmacological Therapy for more information on Pharmacological Therapy
Below is the overview of disease management of Rheumatoid Arthritis:
Rheumatoid Arthritis Symptoms▶
Version: 7 Sep 2015
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- National Institute for Health and Care Excellence. Certolizumab pegol for the treatment of rheumatoid arthritis. NICE website. http://www.nice.org.uk/guidance/ta186/resources/guidance-certolizumab-pegol-for-the-treatment-of-rheumatoid-arthritis-pdf. Feb 2010.
- National Institute for Health and Care Excellence. Rheumatoid arthritis: the management of rheumatoid arthritis in adults. NICE website. http://www.nice.org.uk/guidance/cg79/resources/guidance-rheumatoid-arthritis-pdf. Feb 2009.
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