On completion of the chapter, the reader will be able to:
List the symptoms associated with rheumatoid arthritis.
List the extraarticular manifestations of rheumatoid arthritis.
List the laboratory tests used in diagnosing rheumatoid arthritis.
Define the components of nondrug approaches to assist in the management of rheumatoid arthritis.
Discuss the benefits and drawbacks of the use of nonsteroidal antiinflammatory drugs as monotherapy to treat rheumatoid arthritis.
Define advantages and limitations in the use of chronic corticosteroid therapy for rheumatoid arthritis.
Design a therapeutic plan to treat rheumatoid arthritis based on patient-specific data including disease duration, activity, and prognosis.
Design a monitoring plan to follow disease progression of rheumatoid arthritis.
Design a monitoring plan for drug therapy toxicity in rheumatoid arthritis.
Recommend appropriate testing and vaccinations prior to treatment with drug therapy for rheumatoid arthritis.
Develop a progressive stepwise plan for treatment of rheumatoid arthritis in a patient who does not respond to initial therapy.
Discuss the mechanism of action of the biologic agents etanercept, infliximab, adalimumab, certolizumab, golimumab, abatacept, tocilizumab, and rituximab, and anakinra.
Compare and contrast the adverse effect profile of individual disease-modifying antirheumatic drugs.
List the contraindications to methotrexate therapy.
List the drugs used for treating rheumatoid arthritis that would be contraindicated in pregnancy.
Explain the pathophysiologic mechanisms underlying rheumatoid arthritis.
Formulate appropriate counseling information to be provided to a patient on drug therapy for rheumatoid arthritis, given patient-specific information and the prescribed regimen.
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.
RA 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 three ...