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KEY POINTS

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  • Rheumatoid arthritis is a chronic systemic inflammatory disease that requires early detection and proper treatment to prevent permanent joint damage.

  • All patients with rheumatoid arthritis ought to have pharmacologic therapy; adding nonpharmacologic treatments can further improve quality of life.

  • Although traditional nonbiologic disease-modifying antirheumatic drugs continue to be prescribed, biologic agents are gaining in popularity and continue to be developed.

  • Both the nonbiologic and the biologic disease-modifying antirheumatic drugs have the potential for serious adverse effects. MTM providers can play a key role in proper education and routine monitoring of patients taking these medications.

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INTRODUCTION TO RHEUMATOID ARTHRITIS

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Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease. The disease process is characterized by inflammation of the joints and surrounding tissues, leading to joint destruction over time. The cause of inflammation that leads to RA is unknown, however there may be a genetic component. Additionally, major histocompatibility complex molecules may have a role in determining who will develop RA. Patients with human lymphocyte antigen (HLA) DR4 are 3.5 times more likely to develop RA.2 RA usually involves symmetrical joints, but patients may also experience vasculitis, eye inflammation, rheumatoid nodules, cardiopulmonary disease, and lymphadenopathy. RA affects 1.5 million people over the age of 18 in the United States and is 3 times more common in women than men. The onset of the disease most commonly occurs in people in their fifth or sixth decade of life.1, 2

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Pathophysiology

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Rheumatoid arthritis is an autoimmune disease caused by chronic inflammation of the joint lining. This leads to proliferation of tissue that invades the cartilage and bone. The ongoing inflammatory process causes joint damage, and ultimately leads to joint destruction if left untreated. The immune system of a patient with RA is no longer able to distinguish the self from foreign cells, so it attacks the patient's own body. Additionally, vasoactive substances are released as part of the immune response, causing swelling, warmth, redness, and pain at the site of inflammation.2 Patients may also develop antibodies, called rheumatoid factors. Patients who have circulating rheumatoid factors may have a more aggressive form of the disease than those who do not.

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Clinical Presentation

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The joints involved in RA are commonly small joints within the wrists, hands, and feet, with patients typically presenting with symmetric joint involvement. Larger joints, including shoulders, knees, elbows, and hips, may also be affected, as well as the cervical area of the spine; the lumbar area of the spine is usually not affected.3 Figure 33-1 depicts some of the differences in clinical presentation between RA and osteoarthritis (OA). Highlighting these distinctions can be very helpful when educating a patient in an MTM session.

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Figure 33-1.

Patterns of Joint Involvement in Rheumatoid Arthritis and Osteoarthritis2

Source: Wahl K, Schuna AA. Rheumatoid Arthritis. In: DiPiro JT, ...

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