Diagnosis and Management of Rheumatoid Arthritis

Abstract

heumatoid arthritis (RA) is a chronic, inflammatory joint disease with a worldwide prevalence of about 5 per 1000 adults. The disease affects women 2 to 3 times more often than men and occurs at any age. The peak incidence is in the sixth decade. 1 Previously, RA led to disability, inability to work, and increased mortality. Recent improvement in outcomes has been achieved through a better understanding of RA pathophysiology and development of better outcome measures and therapies.The pathophysiology of RA involves chronic inflammation of the synovial membrane, which can destroy articular cartilage and juxtaarticular bone. 2 Recent discoveries regarding biologic pathways have improved understanding of the phenomena associated with rheumatoid inflammation and their consequences. New molecules and cells in the biologic pathway have been identified and are targets for therapeutic intervention.This review summarizes current evidence regarding the pathophysiology, diagnosis, and treatment of RA. MethodsPubMed was searched on June 18, 2018, for the terms rheumatoid arthritis and pathogenesis or diagnosis or classification. Titles and abstracts were screened by the authors and articles selected based on newly described molecules, new pathogenetic insights, or new biomarkers. The search regarding therapy used evidence from IMPORTANCE Rheumatoid arthritis (RA) occurs in about 5 per 1000 people and can lead to severe joint damage and disability. Significant progress has been made over the past 2 decades regarding understanding of disease pathophysiology, optimal outcome measures, and effective treatment strategies, including the recognition of the importance of diagnosing and treating RA early.OBSERVATIONS Early diagnosis and treatment of RA can avert or substantially slow progression of joint damage in up to 90% of patients, thereby preventing irreversible disability. The development of novel instruments to measure disease activity and identify the presence or absence of remission have facilitated new treatment strategies to arrest RA before joints are damaged irreversibly. Outcomes have been improved by recognizing the benefits of early diagnosis and early therapy with disease-modifying antirheumatic drugs (DMARDs). The treatment target is remission or a state of at least low disease activity, which should be attained within 6 months. Methotrexate is first-line therapy and should be prescribed at an optimal dose of 25 mg weekly and in combination with glucocorticoids; 40% to 50% of patients reach remission or at least low disease activity with this regimen. If this treatment fails, sequential application of targeted therapies, such as biologic agents (eg, tumor necrosis factor [TNF] inhibitors) or Janus kinase inhibitors in combination with methotrexate, have allowed up to 75% of these patients to reach the treatment target over time. New therapies have been developed in response to new pathogenetic findings. The costs of some therapies are considerable, but these costs are decreasing with the advent of biosimilar drugs ...

The genetic pathogenesis, diagnosis and therapeutic insight of rheumatoid arthritis

“…Some of these drugs have been in use for many decades without being entirely replaced by newer drugs . Early diagnosis of RA and prompt initiation of methotrexate, glucocorticoids and other DMARD therapies with regular patients' assessment to achieve a target of remission or low disease state will result in favorable outcomes for most RA patients …”

“…124 Early diagnosis of RA and prompt initiation of methotrexate, glucocorticoids and other DMARD therapies with regular patients' assessment to achieve a target of remission or low disease state will result in favorable outcomes for most RA patients. 39,122,[126][127][128]132 7 | CONCLUSIONS AND PERSPECTIVES…”

Analytical validation of the iSED automated analyzer for erythrocyte sedimentation rate

“…is influenced by other numerous physiological and pathophysiological factors, most significant being anemia, alterations in RBC morphology, and presence of paraproteins, thus limiting its utility in inflammatory conditions. 5 With the introduction of more specific inflammatory biomarkers, its usefulness has decreased and nowadays ESR remains helpful in the diagnosis and monitoring of a limited number of clinical conditions, in particular rheumatoid diseases, 8 orthopedic infections, 9 and Hodgkin's lymphoma. 10 The International Council for Standardization in Haematology (ICSH) defines the Westergren method originally introduced in 1921 as the gold standard method for ESR determination.…”

Correlation of microRNA expression profile with clinical response to tumor necrosis factor inhibitor in treating rheumatoid arthritis patients: A prospective cohort study

“…RA is characterized by joint damage, substantial disability, and other extra-articular comorbidities, which imposes a huge burden on individuals and society. 1,2 In order to alleviate disease, several effective treatments have been used, including glucocorticoid, conventional disease-modifying anti-rheumatic drugs (DMARDs), tumor necrosis factor (TNF) inhibitor, and other biologics. 3 Among these, TNF inhibitor could rapidly relieve inflammation and inhibit the progress of radiology to some extent, which are popularly applied in RA patients.…”