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  • image Rheumatoid arthritis (RA) is a systemic disease characterized by symmetrical inflammation of joints, yet may involve other organ systems.
  • image Control of inflammation is the key to slowing or preventing disease progression as well as managing symptoms.
  • image 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 Disease-modifying antirheumatic drugs (DMARDs) or biologic agents should be started early in the course of the disease and shortly after diagnosis of RA.
  • image 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 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 Patients require careful monitoring for toxicity and therapeutic benefit for the duration of treatment.

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

  1. List the symptoms associated with rheumatoid arthritis.

  2. List the extraarticular 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. Define advantages and limitations in the use of chronic corticosteroid therapy for rheumatoid arthritis.

  7. Design a therapeutic plan to treat rheumatoid arthritis based on patient-specific data including disease duration, activity, and prognosis.

  8. Design a monitoring plan to follow disease progression of rheumatoid arthritis.

  9. Design a monitoring plan for drug therapy toxicity in rheumatoid arthritis.

  10. Recommend appropriate testing and vaccinations prior to treatment with drug therapy for rheumatoid arthritis.

  11. Develop a progressive stepwise plan for treatment of rheumatoid arthritis in a patient who does not respond to initial therapy.

  12. Discuss the mechanism of action of the biologic agents etanercept, infliximab, adalimumab, certolizumab, golimumab, abatacept, tocilizumab, and rituximab, and anakinra.

  13. Compare and contrast the adverse effect profile of individual disease-modifying antirheumatic drugs.

  14. List the contraindications to methotrexate therapy.

  15. List the drugs used for treating rheumatoid arthritis that would be contraindicated in pregnancy.

  16. Explain the pathophysiologic mechanisms underlying rheumatoid arthritis.

  17. 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 ...

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