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  • Image not available.Rheumatoid arthritis (RA) is a systemic disease characterized by symmetrical inflammation of joints yet may involve other organ systems.
  • Image not available. Control of inflammation is the key to slowing or preventing disease progression as well as managing symptoms.
  • Image not available.Drug therapy should be only part of a comprehensive program for patient management which would also include physical therapy, exercise, and rest. Assistive devices and orthopedic surgery may be necessary in some patients.
  • Image not available. Disease-modifying antirheumatic drugs (DMARDs) or biologic agents should be started within 3 months of the diagnosis of RA.
  • Image not available. Nonsteroidal antiinflammatory drugs and/or corticosteroids should be considered adjunctive therapy early in the course of treatment and as needed if symptoms are not adequately controlled with DMARDs.
  • Image not available. When DMARDs used singly are ineffective or not adequately effective, combination therapy with two or more DMARDs or a DMARD plus biologic agent may be used to induce a response.
  • Image not available. Patients require careful monitoring for toxicity and therapeutic benefit for the duration of treatment.

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On completion of the chapter, the reader will be able to:

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  • 1. List the symptoms associated with rheumatoid arthritis.
  • 2. List the extra-articular manifestations of rheumatoid arthritis.
  • 3. List the laboratory tests used in diagnosing rheumatoid arthritis.
  • 4. Define the components of nondrug approaches to assist in the management of rheumatoid arthritis.
  • 5. Discuss the benefits and drawbacks of the use of nonsteroidal antiinflammatory drugs as monotherapy to treat rheumatoid arthritis.
  • 6. Design a therapeutic plan to treat rheumatoid arthritis.
  • 7. Design a monitoring plan to follow disease progression of rheumatoid arthritis.
  • 8. Design a monitoring plan for drug therapy toxicity in rheumatoid arthritis.
  • 9. Develop a progressive stepwise plan for treatment of rheumatoid arthritis in a patient who does not respond to therapy.
  • 10. Discuss the mechanism of action of the biologic agents infliximab, adalimumab, etanercept, anakinra, abatacept, and rituximab.
  • 11. Define major toxicities of disease-modifying antirheumatic drugs.
  • 12. Define advantages and limitations in the use of chronic corticosteroid therapy for rheumatoid arthritis.
  • 13. List the contraindications to methotrexate therapy.
  • 14. List the drugs used for treating rheumatoid arthritis that would be contraindicated in pregnancy.
  • 15. Explain the pathophysiologic mechanisms for rheumatoid arthritis.

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Rheumatoid arthritis (RA) is the most common systemic inflammatory disease characterized by symmetrical joint involvement. Extraarticular involvement, including rheumatoid nodules, vasculitis, eye inflammation, neurologic dysfunction, cardiopulmonary disease, lymphadenopathy, and splenomegaly, can be manifestations of the disease. Although the usual disease course is chronic, some patients will enter a remission spontaneously.

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Rheumatoid arthritis is estimated to have a prevalence of 1% and does not have any racial predilections. It can occur at any age, with increasing prevalence up to the seventh decade of life. The disease is 3 times more common in women. In people ages 15 to 45 years, women predominate by a ratio of 6:1; the sex ratio is approximately equal among patients in the first decade of life and in those older than age 60 years.

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