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KEY POINTS

KEY POINTS

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

  • Pharmacologic therapy must be utilized in patients with RA however, including nonpharmacological options in the treatment plan can lead to improved quality of life.

  • Although traditional nonbiologic disease-modifying antirheumatic drugs remain in use, biologic agents are gaining popularity, and new agents are in development.

  • Serious adverse effects can occur with both the nonbiologic and the biologic disease-modifying antirheumatic drugs. Medication therapy management (MTM) providers can play a key role in proper education and routine monitoring of patients taking these medications.

INTRODUCTION TO RHEUMATOID ARTHRITIS

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, RA may have a genetic component.1 Additionally, major histocompatibility complex molecules may have a role in determining patients 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 approximately 1.3 million people over the age of 18 in the United States and is 3 times more common in women than men.3 The onset of the ­disease is most commonly seen in the fifth or sixth decade of life.1

Pathophysiology

RA 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 patients with RA is no longer able to distinguish self from foreign cells, resulting in the immune system attacking the patient’s own body. Additionally, vasoactive substances are released as part of the immune response and cause swelling, warmth, redness, and pain at the site of inflammation.2 Patients may also develop antibodies, which are called rheumatoid factors. Patients who have circulating rheumatoid factors may have a more aggressive form of the disease than those who do not.2

Clinical Presentation

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 may also be affected, including shoulders, knees, elbows, and hips. The cervical area of the spine may also be affected, but the lumbar area of the spine is usually not.4 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.

FIGURE 33-1

Patterns of joint involvement in rheumatoid arthritis and ...

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