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Rheumatology

Rheumatoid Arthritis: A Brief Review for the Primary Care Physician

June 20, 2016
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As methods for diagnosing rheumatoid arthritis have advanced, primary care physicians emphasize early intervention and now see less of the characteristic joint deformation complications that are common late in the disease process.

Rheumatoid arthritis is a systemic polyarticular inflammatory arthritis that is inextricably intertwined with autoantibodies, rheumatoid factor, and anti-CCP.

  • Preventing complications like functional disabilities necessitates early detection and intervention.
  • As viral infections and other rheumatologic diseases can mimic the symptoms of RA, ruling out these diseases is a must before committing to the diagnosis of RA.
  • Multiple medications can be used to treat RA, and the aim of any treatment regimen should be the remission or return to a low disease state of the RA.
  •  Estimated rates of RA in the United States are 9.8 per 1000 in women and 4.1 per 1000 in men, with the average age of those afflicted at nearly 67 years. The risk of contracting RA over the course of a lifetime is estimated to be between 3-4%.
  • Risk factors for rheumatoid arthritis include, but are not limited to the (HLA)-DRB1 genes, cigarette smoking, and periodontal disease.
  • Starting in 2010 the new ACR/EULAR classification system requires that at least 6 of a possible 10 point-count are warranted for a diagnosis of RA.
  • Serum RF, ACPA, ESR, and CRP tests are those most often used in work-up for RA.
  • The objective of treatment is to reach remission or a low disease state, halting the progression of the disease to mitigate functional disability. An understanding of DMARD therapy, nowadays, is a critical aspect of managing life with RA.

Rheumatoid arthritis (RA) is a not-uncommon systemic polyarticular form of inflammatory arthritis. Its exact causes are, as of now, unclear. RA most commonly presents itself as a symmetric pain and swelling of the synovial joints. Autoantibodies like rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPA) are typically present in patients. If RA is left untreated, there is a very high risk of substantial deformity and disability.

In the past 10 years, the advent of effective disease-modifying antirheumatic drugs such as methotrexate and biologic agents have changed the treatment of RA and the course of the disease, increasing emphasis on early diagnosis and treatment. Multiple studies back up the claim that optimal outcomes are predicated by early intervention. As such, medical practitioners are urged to recognize the importance of early action so that they may formulate early plans of action.

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