Rheumatoid Arthritis

In the Clinic6 July 2010Rheumatoid ArthritisBarbara Turner, MD, MSED, Sankey Williams, MD, Darren Taichman, MD, PhD, Tom W.J. Huizinga, MD, PhD, and Theodore Pincus, MDBarbara Turner, MD, MSEDSearch for more papers by this author, Sankey Williams, MDSearch for more papers by this author, Darren Taichman, MD, PhDSearch for more papers by this author, Tom W.J. Huizinga, MD, PhDSearch for more papers by this author, and Theodore Pincus, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-153-1-201007060-01001 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Editor's Note: This issue of In the Clinic has been updated.Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disease affecting approximately 0.5% of the population. Rheumatoid arthritis is more common in women and may occur at any age, with peak incidence at ages 50 to 60 years. The most prominent feature is symmetrical joint swelling of the feet, hands, and knees, although any joint (and some internal organs) may be affected. Rheumatoid arthritis is a clinical syndrome encompassing several disease subsets, each involving inflammatory cascades that generally lead to joint and organ damage if left untreated. Although laboratory test ...References1. Van Nies JAB, de Jong Z, Van der Helm-van Mil AHM, et al. Improved treatment strategies reduce the increased mortality risk in early RA patients. Rheumatology. In press. Google Scholar2. Aletaha D, Neogi T, Silman A, et al. The 2010 American College of Rheumatology/European League Against Rheumatism classification criteria for rheumatoid arthritis. Arthritis Rheum. 2010. [Forthcoming]. Google Scholar3. Aletaha D, Neogi T, Silman A, et al. The 2010 American College of Rheumatology/European League Against Rheumatism classification criteria for rheumatoid arthritis. Ann Rheum Dis. 2010. [Forthcoming]. Google Scholar4. Thabet MM, Huizinga TW, van der Heijde DM, et al. The prognostic value of baseline erosions in undifferentiated arthritis. Arthritis Res Ther. 2009;11:R155. [PMID: 19832979] Google Scholar5. van der Linden MP, van der Woude D, Ioan-Facsinay A, et al. Value of anti-modified citrullinated vimentin and third-generation anti-cyclic citrullinated peptide compared with second-generation anti-cyclic citrullinated peptide and rheumatoid factor in predicting disease outcome in undifferentiated arthritis and rheumatoid arthritis. Arthritis Rheum. 2009;60:2232-41. [PMID: 19644872] Google Scholar6. Sokka T, Pincus T. Erythrocyte sedimentation rate, C-reactive protein, or rheumatoid factor are normal at presentation in 35%-45% of patients with rheumatoid arthritis seen between 1980 and 2004: analyses from Finland and the United States. J Rheumatol. 2009;36:1387-90. [PMID: 19411389] Google Scholar7. Whiting PF, Smidt N, Sterne JA, et al. Systematic review: accuracy of anti-citrullinated Peptide antibodies for diagnosing rheumatoid arthritis. Ann Intern Med. 2010;152:456-64; W155-66. [PMID: 20368651] Google Scholar8. Croft P, Rigby AS, Boswell R, et al. The prevalence of chronic widespread pain in the general population. J Rheumatol. 1993;20:710-3. [PMID: 8496870] Google Scholar9. Wolfe F, Ross K, Anderson J, et al. The prevalence and characteristics of fibromyalgia in the general population. Arthritis Rheum. 1995;38:19-28. [PMID: 7818567] Google Scholar10. Wolfe F, Cathey MA, Kleinheksel SM. Fibrositis (Fibromyalgia) in rheumatoid arthritis. J Rheumatol. 1984;11:814-8. [PMID: 6596431] Google Scholar11. van der Linden MPM, le Cessie S, Raza K, et al. Long-term impact of delay in assessment of early arthritis patients. Arthritis Rheum. 2010. [Forthcoming]. Google Scholar12. van der Heide A, Jacobs JW, Bijlsma JW, et al. The effectiveness of early treatment with "second-line" antirheumatic drugs. A randomized, controlled trial. Ann Intern Med. 1996;124:699-707. [PMID: 8633829] Google Scholar13. Visser K, Katchamart W, Loza E, et al. Multinational evidence-based recommendations for the use of methotrexate in rheumatic disorders with a focus on rheumatoid arthritis: integrating systematic literature research and expert opinion of a broad international panel of rheumatologists in the 3E Initiative. Ann Rheum Dis. 2009;68:1086-93. [PMID: 19033291] Google Scholar14. van der Heijde D, Klareskog L, Rodriguez-Valverde V, et al; TEMPO Study Investigators. Comparison of etanercept and methotrexate, alone and combined, in the treatment of rheumatoid arthritis: two-year clinical and radiographic results from the TEMPO study, a double-blind, randomized trial. Arthritis Rheum. 2006;54:1063-74. [PMID: 16572441] Google Scholar15. Pincus T, Marcum SB, Callahan LF. Longterm drug therapy for rheumatoid arthritis in seven rheumatology private practices: II. Second line drugs and prednisone. J Rheumatol. 1992;19:1885-94. [PMID: 1294735] Google Scholar16. Yazici Y, Sokka T, Kautiainen H, et al. Long term safety of methotrexate in routine clinical care: discontinuation is unusual and rarely the result of laboratory abnormalities. Ann Rheum Dis. 2005;64:207-11. [PMID: 15208176] Google Scholar17. Haagsma CJ, van Riel PL, de Jong AJ, et al. Combination of sulphasalazine and methotrexate versus the single components in early rheumatoid arthritis: a randomized, controlled, double-blind, 52 week clinical trial. Br J Rheumatol. 1997;36:1082-8. [PMID: 9374925] Google Scholar18. Maillefert JF, Combe B, Goupille P, et al. Long term structural effects of combination therapy in patients with early rheumatoid arthritis: five year follow up of a prospective double blind controlled study. Ann Rheum Dis. 2003;62:764-6. [PMID: 12860733] Google Scholar19. O'Dell JR, Haire C, Erikson N, et al. Efficacy of triple DMARD therapy in patients with RA with suboptimal response to methotrexate. J Rheumatol. 1996;23 (Suppl 44):72-4. Google Scholar20. van Vollenhoven RF, Ernestam S, Geborek P, et al. Addition of infliximab compared with addition of sulfasalazine and hydroxychloroquine to methotrexate in patients with early rheumatoid arthritis (Swefot trial): 1-year results of a randomised trial. Lancet. 2009;374:459-66. [PMID: 19665644] Google Scholar21. Strand V, Cohen S, Schiff M, et al. Treatment of active rheumatoid arthritis with leflunomide compared with placebo and methotrexate. Leflunomide Rheumatoid Arthritis Investigators Group. Arch Intern Med. 1999;159:2542-50. [PMID: 10573044] Google Scholar22. Stein CM, Longmire AW, Minton TA, et al. Cyclosporine-induced alterations in renal function are not associated with lipid peroxidation. Transplantation. 1994;58:386-8. [PMID: 8053066] Google Scholar23. van den Borne BE, Landewé RB, Goei The HS, et al. Cyclosporin A therapy in rheumatoid arthritis: only strict application of the guidelines for safe use can prevent irreversible renal function loss. Rheumatology (Oxford). 1999;38:254-9. [PMID: 10325664] Google Scholar24. Furst DE, Keystone EC, Fleischmann R, et al. Updated consensus statement on biological agents for the treatment of rheumatic diseases, 2009. Ann Rheum Dis. 2010;69 Suppl 1:i2-29. [PMID: 19995740] Google Scholar25. Strand V, Singh JA. Newer biological agents in rheumatoid arthritis: impact on health-related quality of life and productivity. Drugs. 2010;70:121-45. [PMID: 20108988] Google Scholar26. van Vollenhoven RF. Switching between biological agents. Clin Exp Rheumatol. 2004;22:S115-21. [PMID: 15552524] Google Scholar27. Bijlsma JW, Boers M, Saag KG, et al. Glucocorticoids in the treatment of early and late RA. Ann Rheum Dis. 2003;62:1033-7. [PMID: 14583563] Google Scholar28. Sokka T, Kautiainen H, Toloza S, et al; QUEST-RA Group. QUEST-RA: quantitative clinical assessment of patients with rheumatoid arthritis seen in standard rheumatology care in 15 countries. Ann Rheum Dis. 2007;66:1491-6. [PMID: 17412740] Google Scholar29. Pincus T, Swearingen CJ, Luta G, et al. Efficacy of prednisone 1-4 mg/day in patients with rheumatoid arthritis: a randomised, double-blind, placebo controlled withdrawal clinical trial. Ann Rheum Dis. 2009;68:1715-20. [PMID: 19074913] Google Scholar30. van Vliet-Daskalopoulou E, Jentjens T, Scheffer RT. Intra-articular rimexolone in the rheumatoid knee: a placebo-controlled, double-blind, multicentre trial of three doses. Br J Rheumatol. 1987;26:450-3. [PMID: 3318993] Google Scholar31. Saag KG, Teng GG, Patkar NM, et al; American College of Rheumatology. American College of Rheumatology 2008 recommendations for the use of nonbiologic and biologic disease-modifying antirheumatic drugs in rheumatoid arthritis. Arthritis Rheum. 2008;59:762-84. [PMID: 18512708] Google Scholar32. Puolakka K, Kautiainen H, Möttönen T, et al; FIN-RACo Trial Group. Early suppression of disease activity is essential for maintenance of work capacity in patients with recent-onset rheumatoid arthritis: five-year experience from the FIN-RACo trial. Arthritis Rheum. 2005;52:36-41. [PMID: 15641055] Google Scholar33. Prevoo ML, van 't Hof MA, Kuper HH, et al. Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum. 1995;38:44-8. [PMID: 7818570] Google Scholar34. Aletaha D, Smolen J. The Simplified Disease Activity Index (SDAI) and the Clinical Disease Activity Index (CDAI): a review of their usefulness and validity in rheumatoid arthritis. Clin Exp Rheumatol. 2005;23:S100-8. [PMID: 16273793] Google Scholar35. Pincus T, Swearingen CJ, Bergman M, et al. RAPID3 (Routine Assessment of Patient Index Data 3), a rheumatoid arthritis index without formal joint counts for routine care: proposed severity categories compared to disease activity score and clinical disease activity index categories. J Rheumatol. 2008;35:2136-47. [PMID: 18793006] Google Scholar36. Häkkinen A, Sokka T, Kautiainen H, et al. Sustained maintenance of exercise induced muscle strength gains and normal bone mineral density in patients with early rheumatoid arthritis: a 5 year follow up. Ann Rheum Dis. 2004;63:910-6. [PMID: 15249317] Google Scholar37. Lorig K, Lubeck D, Kraines RG, et al. Outcomes of self-help education for patients with arthritis. Arthritis Rheum. 1985;28:680-5. [PMID: 4004977] Google Scholar38. Lorig K, Seleznick M, Lubeck D, et al. The beneficial outcomes of the arthritis self-management course are not adequately explained by behavior change. Arthritis Rheum. 1989;32:91-5. [PMID: 2912467] Google Scholar39. Tanner SB, Callahan LF, Panush R, et al. Dietary and allergic associations with rheumatoid arthritis. Self-report of 704 patients. Arthritis Care Res. 1990;3:189-95. Google Scholar40. van der Woude D, Young A, Jayakumar K, et al. Prevalence of and predictive factors for sustained disease-modifying antirheumatic drug-free remission in rheumatoid arthritis: results from two large early arthritis cohorts. Arthritis Rheum. 2009;60:2262-71. [PMID: 19644846] Google Scholar41. Sokka T, Abelson B, Pincus T. Mortality in rheumatoid arthritis: 2008 update. Clin Exp Rheumatol. 2008;26:S35-61. [PMID: 19026144] Google Scholar42. Pincus T, Esther R, DeWalt DA, et al. Social conditions and self-management are more powerful determinants of health than access to care. Ann Intern Med. 1998;129:406-11. [PMID: 9735069] Google Scholar43. Pincus T, Sokka T, Kautiainen H. Patients seen for standard rheumatoid arthritis care have significantly better articular, radiographic, laboratory, and functional status in 2000 than in 1985. Arthritis Rheum. 2005;52:1009-19. [PMID: 15818706] Google Scholar44. Krause D, Schleusser B, Herborn G, et al. Response to methotrexate treatment is associated with reduced mortality in patients with severe rheumatoid arthritis. Arthritis Rheum. 2000;43:14-21. [PMID: 10643695] Google Scholar45. Choi HK, Hernán MA, Seeger JD, et al. Methotrexate and mortality in patients with rheumatoid arthritis: a prospective study. Lancet. 2002;359:1173-7. [PMID: 11955534] Google Scholar46. Jacobsson LT, Turesson C, Nilsson JA, et al. Treatment with TNF blockers and mortality risk in patients with rheumatoid arthritis. Ann Rheum Dis. 2007;66:670-5. [PMID: 17158824] Google Scholar47. MacLean CH, Saag KG, Solomon DH, et al. Measuring quality in arthritis care: methods for developing the Arthritis Foundation's quality indicator set. Arthritis Rheum. 2004;51:193-202. [PMID: 15077259] Google Scholar48. Khanna D, Arnold EL, Pencharz JN, et al. Measuring process of arthritis care: the Arthritis Foundation's quality indicator set for rheumatoid arthritis. Semin Arthritis Rheum. 2006;35:211-37. [PMID: 16461068] Google Scholar49. Saag K, Kavanaugh A, Smolen J, et al. Quality of care in rheumatology: Opportunities and challenges. Clin Exp Rheumatol. 2007;25(6 Suppl 47):S1-S162. Google Scholar50. Combe B, Landewe R, Lukas C, et al. EULAR recommendations for the management of early arthritis: report of a task force of the European Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis. 2007;66:34-45. [PMID: 16396980] Google Scholar51. Schoels M, Knevel R, Aletaha D, et al. Evidence for treating rheumatoid arthritis to target: results of a systematic literature search. Ann Rheum Dis. 2010;69:638-43. [PMID: 20237123] Google Scholar52. Wolfe F, Michaud K. Resistance of rheumatoid arthritis patients to changing therapy: discordance between disease activity and patients' treatment choices. Arthritis Rheum. 2007;56:2135-42. 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