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For the Chapter in the Schwinghammer Handbook, please go to Chapter 4, Rheumatoid Arthritis.



  • imageThe etiology of rheumatoid arthritis is unknown but is thought to result from a combination of genetic and environmental factors.

  • imageRheumatoid arthritis is a systemic autoimmune condition in which inappropriate activation of innate and adaptive immune responses cause inflammation leading to bone, cartilage, and synovium erosion.

  • imageThe primary goal of treatment includes targeting disease remission/low disease activity ultimately aiming at enhancing quality of life.

  • imageCare should be provided by a rheumatology-trained clinician.

  • imageOptimizing mental health and completing physical therapy are both crucial nonpharmacologic therapies in addition to providing comprehensive disease and treatment education.

  • imageDrug treatment should be started as soon as a diagnosis is established.

  • imageChoice of therapy depends on the level of disease activity, comorbid health conditions, patient preference, and often insurance coverage.

  • imageNonsteroidal anti-inflammatory drugs, analgesics, and corticosteroids are used as adjunctive therapy to disease-modifying antirheumatic drug therapy.

  • imageResponse to therapy is evaluated by patient subjective reports, physical examination, laboratory markers, and imaging.


Patient Care Process for Rheumatoid Arthritis



  • Patient characteristics (eg, age, sex, pregnancy status, insurance)

  • Social history (eg, tobacco/alcohol use, activity)

  • Patient medical history (eg, health conditions, immunizations, recent infections)

  • Family medical history (eg, autoimmune conditions)

  • Current medications

  • Past RA medication trials

  • Subjective symptom report

  • Objective data such as blood pressure, labs (eg, ESR, CRP, CBC), imaging (eg, DEXA, x-ray films, ultrasound), physical examination (eg, number of tender/swollen joints)


  • Patient subjective report (eg, pain score, duration of morning joint stiffness, adherence to therapy, injection technique/medication storage, side effects to drug therapy, disability, fatigue)

  • Change in number of tender/swollen joints, labs, or imaging

  • Cardiovascular risk factors

  • Infection risk and upcoming procedures

  • Patient treatment preference (utilize motivational interviewing as appropriate)


  • Drug therapy (see Table 111-2)

  • Referrals when appropriate (eg, tobacco treatment clinic, podiatry, mental health, social work, physical and/or occupational therapy)

  • Patient education (eg, dosing, side effects, infection risk management, symptom self-monitoring)

  • Order follow-up labs based on therapy chosen (see Table 111-4)


  • Provide patient education regarding rationale for and follow-up of treatment plan

  • Provide patient with written medication changes, time frame for follow-up, and clinic/emergency contact information

  • Coordinate and schedule follow-up

Follow-up: Monitor and Evaluate

  • Subjective symptom changes and impact on daily activities

  • Presence of adverse effects and infections

  • Laboratory results as indicated for therapy

  • Patient adherence to treatment plan

  • Time frame dependent on treatment plan (generally every 1-3 months)

*Collaborate with a rheumatologist.



Direct-to-consumer advertising refers to the marketing of products to patients rather than healthcare professionals. This is a common marketing strategy, particularly for pharmaceutical products. Watch the following advertisements for tofacitinib and adalimumab:

Reflect on the promotional materials ...

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