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Reumatoid Arthritis

Reumatoid arthritis (RA) has a prevalence of 0.5-1.0%, and it affects women more often than men. RA tends to develop during early or middle adulthood (between the ages of 20 and 50 years), but it can also begin in childhood or old age. It has only a slight tendency to run in families. RA is a chronic illness, with a course extending over

Pathogenesis. Rumatoid arthritis is an autoimmune disease, although a virus may trigger the chronic rheumatoid process in vulnerable individuals. This process causes the immune system to attack the synovium of various joints, leading to synovitis. Synovial inflammation accounts for the typical pain warmth, and swelling of the involved rheumatoid arthritis, rumatoid, rumatism, rheumatism, artritis

Clinical manifestations

RA is a chronic, symmetric polyarthritis. The polyarthritis is often deforming. About 80% of patients describe a slowly progressive onset over weeks or months. RA may wax and wane, and it may

Inflammatory features

The joints in RA are swollen, tender, slightly warm, and stiff. Synovial fluid shows active inflammation:

Patients with RA usually have profound and prolonged morning stiffness. Fatigue, anemia of chronic disease, and severe constitutional illness (eg, fever, vasculitis, pericarditis, myocarditis, Felty's syndrome) are common.

Joint involvement. RA may begin in one or two joints, but it almost invariably progresses to affect 20 or more. In some cases, joint involvement is nearly symmetric, affecting the same finger joints on each

Proliferative/erosive features. The inflamed synovial tissue evolves into a thickened, boggy mass

Joint deformity. Deformities of RA are more likely to be the result of damage to the soft tissues and


RA is a clinical diagnosis. The presence of arthritis excludes the many forms of soft tissue rheumatism (eg, tendinitis, bursitis). The degree of

The pannus is often palpable as a rubbery mass of tissue around a joint. Finding pannus on

Laboratory tests

The rheumatoid factor assay helps to confirm the diagnosis of RA. Rheumatoid factor serves as a marker for RA, but it is not reliable because 1-2% of the normal population have low levels of

Treatment of rheumatoid arthritis

Disease-modifying antirheumatic drugs

Virtually all patients should start taking a disease-modifying antirheumatic drug (DMARDs) as soon as the diagnosis of RA is made. Treatment should continue for the duration of the disease.

The early and aggressive use of these agents reduces acute symptoms and decreases disability over the long term. These drugs are no more toxic than high-dose NSAIDs.

Methotrexate is the treatment of choice because of demonstrated efficacy and long-term tolerability.

Hydroxychloroquine (Plaquenil), 200-400 mg PO qd, is recommended for patients with mild

Etanercept (Enbrel). After twice-weekly subcutaneous injections of etanercept (recombinant human tumor necrosis factor receptor), 25 mg, at 3 months, 62% improve. Etanercept is well tolerated and is

Infliximab (Remicade) is given intravenously for use in refractory disease. Infliximab is an anti-tumor necrosis factor monoclonal antibody. Infliximab is

Leflunomide (Arava), which inhibits pyrimidine synthesis, is an oral drug considered as a possible alternative to methotrexate. The dosage is 100 mg PO daily for three days followed by a

Nonsteroidal antiinflammatory drugs. Most patients will gain short-term symptomatic relief from

Corticosteroids . These drugs may relieve the symptoms of RA, but they are potentially dangerous, with many long-term side effects. They should be reserved for