Rheumatoid Arthritis Pharmacotherapy

Rheumatoid Arthritis Pharmacotherapy

1. Definition & disease overview

• Rheumatoid arthritis (RA) is a chronic, progressive, systemic autoimmune disease characterised by joint inflammation, synovial proliferation (pannus) and destruction of articular cartilage; multiple small joints of hands and feet are preferentially and symmetrically affected, with deformities developing as disease progresses (KDT 8e Ch.15, pp.227–8).
• RA affects about 1% of the population, shortens life, and reduces mobility and quality of life — it is a systemic immunologic disease, not merely a local arthropathy (Katzung 16e Ch.36, p.681; G&G 14e Ch.42, p.847).
• The course is waxing and waning ("flares" and remissions); it is a crippling disorder if untreated (KDT 8e Ch.15, p.227).
• Diagnosis is supported by rheumatoid factor (RF) and anti-cyclic-citrullinated-peptide (anti-CCP) antibody positivity, raised ESR and C-reactive protein (CRP), and characteristic radiographic erosions; seronegativity predicts a relatively better methotrexate response (KDT 8e Ch.15, p.236 [problem-directed study]; Katzung 16e Ch.36, p.689).