Questions and Answers
What is the primary effect of rheumatoid arthritis on the body?
Inflammation of the lining of the synovial joints
What is the primary goal of treatment in rheumatoid arthritis?
To achieve a low disease activity state
What is the role of disease-modifying anti-rheumatic drugs (DMARDs) in rheumatoid arthritis?
To efficiently attenuate disease activity and substantially decrease and/or delay joint deformity
What is the significance of early diagnosis in rheumatoid arthritis?
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What is the challenge in diagnosing rheumatoid arthritis?
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What is the purpose of continuously monitoring disease activity in rheumatoid arthritis?
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What is the characteristic of rheumatoid arthritis primarily responsible for affecting the body?
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In rheumatoid arthritis, which group is more frequently affected?
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What is the primary site of involvement in rheumatoid arthritis?
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What is one of the clinical manifestations of symmetrical joint involvement in rheumatoid arthritis?
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What is the desirable outcome of early diagnosis in rheumatoid arthritis?
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What is the purpose of disease activity monitoring in rheumatoid arthritis?
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What is the limitation of anti-inflammatory drugs and corticosteroids in rheumatoid arthritis?
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What is the role of disease-modifying anti-rheumatic drugs (DMARDs) in rheumatoid arthritis?
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What is the categorization of therapy in rheumatoid arthritis?
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What is the desired state of disease activity in rheumatoid arthritis management?
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Study Notes
Rheumatoid Arthritis (RA)
- RA is a chronic autoimmune disease
- More frequent in females and commonly observed in the elderly
- Primarily affects the lining of the synovial joints and can cause progressive disability
Clinical Manifestations
- Symmetrical joint involvement
- Swelling, redness, and limited range of motion
Desirable Outcomes
- Reduced joint destruction
- Less radiologic progression
- No functional disability
- Disease modifying anti-rheumatic drugs (DMARD)-free remission
Diagnosis and Treatment
- Early diagnosis is challenging and relies on clinical information, physical examination, blood tests, and imaging analysis
- Treatment strategy aims to expedite diagnosis and rapidly achieve a low disease activity state
- Continuous monitoring of disease activity is necessary to achieve full suppression (clinical remission)
Medications
- Anti-inflammatory drugs (NSAIDs) and corticosteroids relieve stiffness and pain, but do not moderate disease progression
- DMARDs efficiently attenuate disease activity and decrease/delay joint deformity
- Therapy classification includes traditional synthetic drugs, biological DMARDs, and potential small molecules
Pathogenesis
- Two major subtypes of RA: presence or absence of anti-citrullinated protein antibodies (ACPAs)
- Citrullination is catalyzed by the calcium-dependent enzyme peptidylarginine-deiminase (PAD)
- ACPAs can be detected in 67% of RA patients and provide a diagnostic reference for early and undifferentiated arthritis
- ACPA-positive subset of RA has a more aggressive clinical phenotype
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