Management of Rheumatoid Arthritis
Corresponding Author(s) : Amal Ghouraba
a_abdallah@hotmail.com
International Journal of Allied Medical Sciences and Clinical Research,
Vol. 2 No. 3 (2014): 2014 Volume 2- Issue -3
Abstract
Rheumatoid arthritis (RA) can be defined as an autoimmune inflammatory disease which is represented in about 1% of the world population and occurs in the middle age with increasing frequency in older population. RA has several types which can be caused by joint inflammation, - bone or joint damage. Scientists were unable to determine the causes of such inflammation until few years ago when some evidences or clues were unveiled that involved mainly genetics and environmental factors. Although there is no known complete cure of RA, treatment aim to achieve several goals which are pain relief, slow joint degeneration and improve patient well- being. To achieve that, several approaches could be applied including lifestyle, medication, routine monitoring and surgery.
Keywords
RA
DMARDs
NSAIDs
corticosteroids
1.
Amal Ghouraba. Management of Rheumatoid Arthritis. Int. J. of Allied Med. Sci. and Clin. Res. [Internet]. 2020 Aug. 1 [cited 2026 Apr. 16];2(3):177-81. Available from: https://ijamscr.com/ijamscr/article/view/73
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References
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1. Keskin G, Inal A, Keskin D, Pekel A, Baysal O, Dizer U and Sengül A. Diagnostic utility of anti-cyclic citrullinated peptide and anti-modified citrullinated vimentin antibodies in rheumatoid arthritis. Protein Pept. Lett. 2008;15:314–7.
2. Egerer K, Feist E and Burmester GR. The serological diagnosis of rheumatoid arthritis: antibodies to citrullinated antigens. Dtsch. Arztebl. Int. 2009; 106(10):159-63.
3. Edward D and Harris Jr. Rheumatoid Arthritis — Pathophysiology and Implications for Therapy. N Engl J Med. 1990; 322:1277-89.
4. Visser H. Early diagnosis of rheumatoid arthritis. Best Pract Res Clin Rheumatol. 2005 ;19(1):55-72.
5. Wasserman AM. Diagnosis and Management of Rheumatoid Arthritis. American Family Physician. 2011; 84(11):1245–52.
6. Saag KG, Teng GG, Patkar NM, et al. American College of Rheumatology 2008 recommendations for the use of nonbiologic and biologic disease-modifying antirheumatic drugs in rheumatoid arthritis. Arthritis Rheum. 2008; 59(6):762–84.
7. Richards BL, Whittle SL, Buchbinder R. Muscle relaxants for pain management in rheumatoid arthritis. In Richards, Bethan L. Cochrane database of systematic reviews (Online).2012; 1: CD008922. doi:10.1002/14651858.CD008922.pub2. PMID 22258993.
8. Scott DL, Wolfe F, Huizinga TW. Rheumatoid arthritis. Lancet. 2010; 376(9746): 1094–108.
9. Hurkmans E, van der Giesen FJ, Vliet Vlieland TP, Schoones J, Van den Ende EC. Dynamic exercise programs (aerobic capacity and/or muscle strength training) in patients with rheumatoid arthritis. In Hurkmans, Emalie. Cochrane database of systematic reviews (Online). 2009; (4): CD006853. doi:10.1002/14651858.CD006853.pub2. PMID 19821388.
10. DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG and Posey LM (2008) Pharmacotherapy: a pathophysiologic approach. 7th ed. New York: McGraw-Hill, ISBN 978-0-07-147899-1.
11. Shea B, Swinden MV, Tanjung Ghogomu E, Ortiz Z, Katchamart W, Rader T, Bombardier C, Wells GA and Tugwell P. Folic acid and folinic acid for reducing side effects in patients receiving methotrexate for rheumatoid arthritis. The Cochrane database of systematic reviews. 2013; 5: CD000951. doi:10.1002/14651858.CD000951.pub2. PMID 23728635.
12. van Vollenhoven RF. treatment of rheumatoid arthritis: state of the art 2009. Nat. Rev. Rheumatol. 2009; 5,531–541;doi:10.1038/nrrheum.2009.182.
13. O’Dell, J. R. et al. Treatment of rheumatoid arthritis with methotrexate alone, sulfasalazine
and hydroxychloroquine, or a combination of all three medications. N. Engl. J. Med. 1996; 334,
1287–91.
14. Weinblatt ME, Kremer JM, Coblyn JS, Maier AL, Helfgott SM, Morrell M, Byrne VM, Kaymakcian MV and Strand V. Pharmacokinetics, safety, and efficacy of combination treatment with methotrexate and leflunomide in patients with active rheumatoid arthritis. Arthritis Rheum. 1999; 42, 1322-8.
15. Aaltonen KJ, Virkki LM, Malmivaara A, Konttinen YT, Nordström DC, Blom M. Systematic review and meta-analysis of the efficacy and safety of existing TNF blocking agents in treatment of rheumatoid arthritis. In Hernandez, Adrian V. PLoS ONE. 2012; 7(1): e30275. doi:10.1371/journal.pone.0030275. PMC 3260264. PMID 22272322.
16. Radner H, Ramiro S, Buchbinder R, Landewé RB, van der Heijde D, Aletaha D. Pain management for inflammatory arthritis (rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis and other spondyloarthritis) and gastrointestinal or liver comorbidity. In Radner, Helga. Cochrane database of systematic reviews (Online). 2012; 1: CD008951. doi:10.1002/14651858.CD008951.pub2. PMID 22258995.
17. Chen YF, Jobanputra P, Barton P, Bryan S, Fry-Smith A, Harris G, Taylor RS. Cyclooxygenase-2 selective non-steroidal anti-inflammatory drugs (etodolac, meloxicam, celecoxib, rofecoxib, etoricoxib, valdecoxib and lumiracoxib) for osteoarthritis and rheumatoid arthritis: a systematic review and economic evaluation". Health technology assessment (Winchester, England). 2008; 12(11):1–278, iii. PMID 18405470.
18. Wang X, Tian HJ, Yang HK, Wanyan P and Peng YJ.Meta-analysis: cyclooxygenase-2 inhibitors are no better than nonselective nonsteroidal anti-inflammatory drugs with proton pump inhibitors in regard to gastrointestinal adverse events in osteoarthritis and rheumatoid arthritis. European journal of gastroenterology & hepatology. 2001; 23(10): 876–80. doi:10.1097/MEG.0b013e328349de81. PMID 21900785.
19. Harris ED, Emkey RD, Nichols JE and Newberg A. Low dose prednisone therapy in
rheumatoid arthritis: a double blind study. J. Rheumatol. 1983; 10,713–21.
References
1. Keskin G, Inal A, Keskin D, Pekel A, Baysal O, Dizer U and Sengül A. Diagnostic utility of anti-cyclic citrullinated peptide and anti-modified citrullinated vimentin antibodies in rheumatoid arthritis. Protein Pept. Lett. 2008;15:314–7.
2. Egerer K, Feist E and Burmester GR. The serological diagnosis of rheumatoid arthritis: antibodies to citrullinated antigens. Dtsch. Arztebl. Int. 2009; 106(10):159-63.
3. Edward D and Harris Jr. Rheumatoid Arthritis — Pathophysiology and Implications for Therapy. N Engl J Med. 1990; 322:1277-89.
4. Visser H. Early diagnosis of rheumatoid arthritis. Best Pract Res Clin Rheumatol. 2005 ;19(1):55-72.
5. Wasserman AM. Diagnosis and Management of Rheumatoid Arthritis. American Family Physician. 2011; 84(11):1245–52.
6. Saag KG, Teng GG, Patkar NM, et al. American College of Rheumatology 2008 recommendations for the use of nonbiologic and biologic disease-modifying antirheumatic drugs in rheumatoid arthritis. Arthritis Rheum. 2008; 59(6):762–84.
7. Richards BL, Whittle SL, Buchbinder R. Muscle relaxants for pain management in rheumatoid arthritis. In Richards, Bethan L. Cochrane database of systematic reviews (Online).2012; 1: CD008922. doi:10.1002/14651858.CD008922.pub2. PMID 22258993.
8. Scott DL, Wolfe F, Huizinga TW. Rheumatoid arthritis. Lancet. 2010; 376(9746): 1094–108.
9. Hurkmans E, van der Giesen FJ, Vliet Vlieland TP, Schoones J, Van den Ende EC. Dynamic exercise programs (aerobic capacity and/or muscle strength training) in patients with rheumatoid arthritis. In Hurkmans, Emalie. Cochrane database of systematic reviews (Online). 2009; (4): CD006853. doi:10.1002/14651858.CD006853.pub2. PMID 19821388.
10. DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG and Posey LM (2008) Pharmacotherapy: a pathophysiologic approach. 7th ed. New York: McGraw-Hill, ISBN 978-0-07-147899-1.
11. Shea B, Swinden MV, Tanjung Ghogomu E, Ortiz Z, Katchamart W, Rader T, Bombardier C, Wells GA and Tugwell P. Folic acid and folinic acid for reducing side effects in patients receiving methotrexate for rheumatoid arthritis. The Cochrane database of systematic reviews. 2013; 5: CD000951. doi:10.1002/14651858.CD000951.pub2. PMID 23728635.
12. van Vollenhoven RF. treatment of rheumatoid arthritis: state of the art 2009. Nat. Rev. Rheumatol. 2009; 5,531–541;doi:10.1038/nrrheum.2009.182.
13. O’Dell, J. R. et al. Treatment of rheumatoid arthritis with methotrexate alone, sulfasalazine
and hydroxychloroquine, or a combination of all three medications. N. Engl. J. Med. 1996; 334,
1287–91.
14. Weinblatt ME, Kremer JM, Coblyn JS, Maier AL, Helfgott SM, Morrell M, Byrne VM, Kaymakcian MV and Strand V. Pharmacokinetics, safety, and efficacy of combination treatment with methotrexate and leflunomide in patients with active rheumatoid arthritis. Arthritis Rheum. 1999; 42, 1322-8.
15. Aaltonen KJ, Virkki LM, Malmivaara A, Konttinen YT, Nordström DC, Blom M. Systematic review and meta-analysis of the efficacy and safety of existing TNF blocking agents in treatment of rheumatoid arthritis. In Hernandez, Adrian V. PLoS ONE. 2012; 7(1): e30275. doi:10.1371/journal.pone.0030275. PMC 3260264. PMID 22272322.
16. Radner H, Ramiro S, Buchbinder R, Landewé RB, van der Heijde D, Aletaha D. Pain management for inflammatory arthritis (rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis and other spondyloarthritis) and gastrointestinal or liver comorbidity. In Radner, Helga. Cochrane database of systematic reviews (Online). 2012; 1: CD008951. doi:10.1002/14651858.CD008951.pub2. PMID 22258995.
17. Chen YF, Jobanputra P, Barton P, Bryan S, Fry-Smith A, Harris G, Taylor RS. Cyclooxygenase-2 selective non-steroidal anti-inflammatory drugs (etodolac, meloxicam, celecoxib, rofecoxib, etoricoxib, valdecoxib and lumiracoxib) for osteoarthritis and rheumatoid arthritis: a systematic review and economic evaluation". Health technology assessment (Winchester, England). 2008; 12(11):1–278, iii. PMID 18405470.
18. Wang X, Tian HJ, Yang HK, Wanyan P and Peng YJ.Meta-analysis: cyclooxygenase-2 inhibitors are no better than nonselective nonsteroidal anti-inflammatory drugs with proton pump inhibitors in regard to gastrointestinal adverse events in osteoarthritis and rheumatoid arthritis. European journal of gastroenterology & hepatology. 2001; 23(10): 876–80. doi:10.1097/MEG.0b013e328349de81. PMID 21900785.
19. Harris ED, Emkey RD, Nichols JE and Newberg A. Low dose prednisone therapy in
rheumatoid arthritis: a double blind study. J. Rheumatol. 1983; 10,713–21.
2. Egerer K, Feist E and Burmester GR. The serological diagnosis of rheumatoid arthritis: antibodies to citrullinated antigens. Dtsch. Arztebl. Int. 2009; 106(10):159-63.
3. Edward D and Harris Jr. Rheumatoid Arthritis — Pathophysiology and Implications for Therapy. N Engl J Med. 1990; 322:1277-89.
4. Visser H. Early diagnosis of rheumatoid arthritis. Best Pract Res Clin Rheumatol. 2005 ;19(1):55-72.
5. Wasserman AM. Diagnosis and Management of Rheumatoid Arthritis. American Family Physician. 2011; 84(11):1245–52.
6. Saag KG, Teng GG, Patkar NM, et al. American College of Rheumatology 2008 recommendations for the use of nonbiologic and biologic disease-modifying antirheumatic drugs in rheumatoid arthritis. Arthritis Rheum. 2008; 59(6):762–84.
7. Richards BL, Whittle SL, Buchbinder R. Muscle relaxants for pain management in rheumatoid arthritis. In Richards, Bethan L. Cochrane database of systematic reviews (Online).2012; 1: CD008922. doi:10.1002/14651858.CD008922.pub2. PMID 22258993.
8. Scott DL, Wolfe F, Huizinga TW. Rheumatoid arthritis. Lancet. 2010; 376(9746): 1094–108.
9. Hurkmans E, van der Giesen FJ, Vliet Vlieland TP, Schoones J, Van den Ende EC. Dynamic exercise programs (aerobic capacity and/or muscle strength training) in patients with rheumatoid arthritis. In Hurkmans, Emalie. Cochrane database of systematic reviews (Online). 2009; (4): CD006853. doi:10.1002/14651858.CD006853.pub2. PMID 19821388.
10. DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG and Posey LM (2008) Pharmacotherapy: a pathophysiologic approach. 7th ed. New York: McGraw-Hill, ISBN 978-0-07-147899-1.
11. Shea B, Swinden MV, Tanjung Ghogomu E, Ortiz Z, Katchamart W, Rader T, Bombardier C, Wells GA and Tugwell P. Folic acid and folinic acid for reducing side effects in patients receiving methotrexate for rheumatoid arthritis. The Cochrane database of systematic reviews. 2013; 5: CD000951. doi:10.1002/14651858.CD000951.pub2. PMID 23728635.
12. van Vollenhoven RF. treatment of rheumatoid arthritis: state of the art 2009. Nat. Rev. Rheumatol. 2009; 5,531–541;doi:10.1038/nrrheum.2009.182.
13. O’Dell, J. R. et al. Treatment of rheumatoid arthritis with methotrexate alone, sulfasalazine
and hydroxychloroquine, or a combination of all three medications. N. Engl. J. Med. 1996; 334,
1287–91.
14. Weinblatt ME, Kremer JM, Coblyn JS, Maier AL, Helfgott SM, Morrell M, Byrne VM, Kaymakcian MV and Strand V. Pharmacokinetics, safety, and efficacy of combination treatment with methotrexate and leflunomide in patients with active rheumatoid arthritis. Arthritis Rheum. 1999; 42, 1322-8.
15. Aaltonen KJ, Virkki LM, Malmivaara A, Konttinen YT, Nordström DC, Blom M. Systematic review and meta-analysis of the efficacy and safety of existing TNF blocking agents in treatment of rheumatoid arthritis. In Hernandez, Adrian V. PLoS ONE. 2012; 7(1): e30275. doi:10.1371/journal.pone.0030275. PMC 3260264. PMID 22272322.
16. Radner H, Ramiro S, Buchbinder R, Landewé RB, van der Heijde D, Aletaha D. Pain management for inflammatory arthritis (rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis and other spondyloarthritis) and gastrointestinal or liver comorbidity. In Radner, Helga. Cochrane database of systematic reviews (Online). 2012; 1: CD008951. doi:10.1002/14651858.CD008951.pub2. PMID 22258995.
17. Chen YF, Jobanputra P, Barton P, Bryan S, Fry-Smith A, Harris G, Taylor RS. Cyclooxygenase-2 selective non-steroidal anti-inflammatory drugs (etodolac, meloxicam, celecoxib, rofecoxib, etoricoxib, valdecoxib and lumiracoxib) for osteoarthritis and rheumatoid arthritis: a systematic review and economic evaluation". Health technology assessment (Winchester, England). 2008; 12(11):1–278, iii. PMID 18405470.
18. Wang X, Tian HJ, Yang HK, Wanyan P and Peng YJ.Meta-analysis: cyclooxygenase-2 inhibitors are no better than nonselective nonsteroidal anti-inflammatory drugs with proton pump inhibitors in regard to gastrointestinal adverse events in osteoarthritis and rheumatoid arthritis. European journal of gastroenterology & hepatology. 2001; 23(10): 876–80. doi:10.1097/MEG.0b013e328349de81. PMID 21900785.
19. Harris ED, Emkey RD, Nichols JE and Newberg A. Low dose prednisone therapy in
rheumatoid arthritis: a double blind study. J. Rheumatol. 1983; 10,713–21.