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NetWellness provides the highest quality health information and education services created and evaluated by faculty of our partner universities.
Saturday, November 21, 2009
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NetWellness provides the highest quality health information and education services created and evaluated by faculty of our partner universities.
Saturday, November 21, 2009
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Rheumatoid Arthritis (RA) is a systemic autoimmune disease that primarily causes joint inflammation. Approximately 1% of the North American population, at any given time, is affected by the disease.1 RA can occur at any age, but is commonly seen in people between 40 and 70.2
The inflammation of RA may cause changes of joints and surrounding anatomy. These changes may include proliferation of the joint lining (synovial membrane) or structural damage to cartilage, bone, and ligaments. The severity of RA is variable, ranging from self-limited to mild, chronic activity to severe, destructive arthritis. While the joint inflammation may certainly cause the symptom of pain, the destructive potential of the disease can also lead to joint deformity, joint dysfunction, and functional decline of an individual.
The most widely used tool for classifying RA is the American College of Rheumatology (formerly the American Rheumatism Association) 1987 revised criteria for the classification of rheumatoid arthritis. Listed below are some common clinical characteristics of RA used by the classification criteria:
There are three goals for the treatment of RA:
Current therapies available do not allow for a cure of the disease; however, medications may helpful in obtaining one or more goals of treatment. Medications that help slow or halt the progression of joint damage are considered Disease Modifying Anti-Rheumatic Drugs (DMARD's). Medications may be used alone or in combination in order an attempt to reach the desired goals. Below is a table of some, but not all, medications used for the treatment of RA.
| Medicine/Class | Symptom Relief | Disease Modifying |
| Non-Steroidal Anti-inflammatory (NSAID) i.e., Ibuprofen Naproxen Diclofenac Celecoxib |
Yes |
No |
| Corticosteroid (Prednisone Medrol) |
Yes |
?* |
| Tetracyline derivative Doxycycline Minocycline |
Yes |
?* |
| Hydroxychloroquine (Plaquenil) |
Yes |
Yes |
| Sulfasalazine (Azulfidine) |
Yes |
Yes |
| Methotrexate (Rheumatrex, Trexall) |
Yes |
Yes |
| Leflunomide (Arava) |
Yes |
Yes |
| Anakinra (Kineret) |
Yes |
Yes |
| Etanercept (Enbrel) |
Yes |
Yes |
| Infliximab (Remicade) |
Yes |
Yes |
| Adalimumab (Humira) |
Yes |
Yes |
| Abatacept (Orencia) |
Yes |
Yes |
| Rituximab (Rituxan) |
Yes |
Likely |
| Golimumab (Simponi) |
Yes |
?* |
| Certolizumab (Cimzia) |
Yes |
?* |
*Disease modifying potential is debated amongst experts. There is known data, but its significance is contentious.
Your health care provider may use a number of tools or questions to assess your response to medications prescribed for the treatment of RA. Your provider may assess the number of tender and/or swollen joints that you have in comparison to previous visits. They may ask you the time it takes to reach maximal improvement of your morning stiffness awakening. X-rays may be taken over specific intervals to assess for progression or lack of progression of RA-induced joint damage.
In advance of your appointment, the office may request that you complete a health assessment survey gauging your symptoms and functions. One such survey is the Health Assessment Questionnaire developed at the Stanford University School of Medicine. This survey can be printed, completed and taken to your health care provider.
1. Gabriel SE, Crowson, O'Fallon WM. The epidemiology of rheumatoid arthritis in Rochester, MN. Arthritis Rheum 1999;42:415-20.
2. Symmons DPM, Barrett EM, Bankhead CR, et al. The incidence of rheumatoid arthritis in the United Kingdom: Results from the Norfolk Arthritis Register. Br J Rheumatol 1994;33:735-9.
This article is a NetWellness exclusive. 
Last Reviewed: Jun 11, 2009
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Raymond Hong, MD, MBA, FACR Assistant Professor Division of Rheumatology University Hospitals School of Medicine Case Western Reserve University |
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