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LEARNING OBJECTIVES

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LEARNING OBJECTIVES

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

  1. Identify risk factors for developing rheumatoid arthritis (RA).

  2. Describe the pathophysiology of RA, with emphasis on the specific immunologic components.

  3. Discuss the comorbidities associated with RA.

  4. Recognize the typical clinical presentation of RA.

  5. Create treatment goals for a patient with RA.

  6. Compare the available pharmacotherapeutic options, selecting the most appropriate regimen for a given patient.

  7. Propose a patient education plan that includes nonpharmacologic and pharmacologic treatment measures.

  8. Formulate a monitoring plan to evaluate the safety and efficacy of a therapeutic regimen designed for an individual patient with RA.

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KEY CONCEPTS

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  • Image not available. Comorbidities with the greatest impact on morbidity and mortality associated with rheumatoid arthritis (RA) are: (a) cardiovascular disease, (b) infections, (c) malignancy, and (d) osteoporosis.

  • Image not available. The most clinically important features associated with poor long-term outcomes include: (a) functional limitation (defined by use of standard measurement scales such as the Health Assessment Questionnaire [HAQ] score), (b) extraarticular disease, (c) positive rheumatoid factor, (d) positive anticyclic citrullinated peptide (anti-CCP) antibodies, and/or (e) bony erosions by radiography.

  • Image not available. The goals of treatment for RA are to: (a) reduce or eliminate pain, (b) protect articular structures, (c) control systemic complications, (d) prevent loss of joint function, and (e) improve or maintain quality of life.

  • Image not available. It is imperative that the initiation of one or more disease-modifying antirheumatic drugs (DMARDs) occurs in all patients within the first 3 months of diagnosis to reduce joint erosion.

  • Image not available. Methotrexate is the nonbiologic DMARD of choice because of its documented efficacy and safety profile when monitored appropriately.

  • Image not available. The risk of infection in patients treated with biologic DMARDs must be considered when selecting and monitoring therapy.

  • Image not available. Women of childbearing potential and their partners must be counseled to: (a) use proper birth control while undergoing treatment for RA, and (b) involve healthcare providers in discussions regarding family planning to carefully consider all treatment options available.

  • Image not available. In addition to designing an individualized therapeutic regimen to control the progression of RA, the clinician must evaluate the presence of comorbidities and implement measures to control the increased risk.

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INTRODUCTION

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Rheumatoid arthritis (RA) is a complex systemic inflammatory condition manifesting initially as symmetric swollen and tender joints of the hands and/or feet. Some patients may experience mild articular (joint) disease, whereas others may present with aggressive disease and/or extraarticular manifestations. The systemic inflammation of RA leads to joint destruction, disability, and premature death. Juvenile idiopathic arthritis (JIA), formerly known as juvenile rheumatoid arthritis (JRA), is the most common form of arthritis in children.

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EPIDEMIOLOGY AND ETIOLOGY

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RA affects approximately 1% of the U.S. population and 1% to 2% of the world's population.1,2 Patients with RA have a 50% increased risk of premature death and a decreased life expectancy of 3 to 10 years compared with individuals without RA.3 The underlying ...

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