Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease of unknown cause. The hallmark feature of this condition is persistent symmetric polyarthritis (synovitis) that affects the hands and feet, although any joint lined by a synovial membrane may be involved. Extra-articular involvement of organs such as the skin, heart, lungs, and eyes can be significant.

No test results are pathognomonic for rheumatoid arthritis, but the presence of both anti-CCP antibodies and rheumatoid factor is highly specific for rheumatoid arthritis (RA). 

Early therapy with disease-modifying antirheumatic drugs (DMARDs) has become the standard of care, as it not only can more efficiently retard disease progression than later treatment but also may induce more remissions. (See Treatment Strategies and Management.) Many of the newer DMARD therapies, however, are immunosuppressive in nature, leading to a higher risk for partially masked serious bacterial, and sometimes fungal, infections. 

Macrophage activation syndrome is a life-threatening complication of rheumatoid arthritis (RA) that requires immediate treatment with high-dose steroids and cyclosporin A. 

Cervical spine involvement usually affects C1-C2 and may potentially cause serious neurologic consequences. Patients who are to undergo intubation or procedures that may involve manipulation of the neck should undergo careful evaluation of the cervical spine.

Optimal care of patients with RA requires an integrated approach of pharmacologic and nonpharmacologic therapies, such as DMARDs, biologics, NSAIDs, analgesics, glucocorticoids, and immunomodulators. 

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