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