Management of rheumatoid arthritis

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Abstract

The management of rheumatoid arthritis (RA) has changed substantially over recent years. The emphases are now on early recognition of persistent synovitis in primary care, rapid referral to specialist services and prompt use of disease-modifying anti-rheumatic drugs (DMARDs). For patients with newly diagnosed active RA, a combination of DMARDs should be offered as first-line treatment as soon as possible. Corticosteroids should be administered in early disease, but are not a good long-term strategy for most patients. A multidisciplinary team is important, and patient education is essential. Tumour necrosis factor-alpha inhibitors and other cytokine modulators have had a big impact on the management of RA not responding to conventional DMARDs, but in the UK their use has been restricted by cost to patients who have failed on two DMARDs with ongoing active disease. It is sometimes possible to reduce therapy in patients who are doing well, but whether DMARDs can be safely stopped in all patients in remission is highly contentious. In future there may be improvements in early diagnosis and better prognostic markers, and health economic arguments may be able to extend the eligibility for biological drugs so that pharmacological strategies will make remission the rule and not the exception. © 2009 Elsevier Ltd. All rights reserved.

Author-supplied keywords

  • *rheumatoid arthritis/di [Diagnosis]
  • *rheumatoid arthritis/dm [Disease Management]
  • *rheumatoid arthritis/dt [Drug Therapy]
  • abatacept/dt [Drug Therapy]
  • abatacept/pe [Pharmacoeconomics]
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  • adalimumab/sc [Subcutaneous Drug Administration]
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  • aurothiomalate/dt [Drug Therapy]
  • aurothiomalate/im [Intramuscular Drug Administrati
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  • azathioprine/dt [Drug Therapy]
  • combination chemotherapy
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  • corticosteroid/ar [Intraarticular Drug Administrat
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  • corticosteroid/dt [Drug Therapy]
  • corticosteroid/im [Intramuscular Drug Administrati
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  • cost effectiveness analysis
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  • cyclosporin A/po [Oral Drug Administration]
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  • disease modifying antirheumatic drug/dt [Drug Ther
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  • etanercept/sc [Subcutaneous Drug Administration]
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  • health care personnel management
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  • human
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  • hydroxychloroquine/po [Oral Drug Administration]
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  • methotrexate/po [Oral Drug Administration]
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  • methylprednisolone/im [Intramuscular Drug Administ
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  • nonsteroid antiinflammatory agent/dt [Drug Therapy
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  • patient care
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  • rituximab/dt [Drug Therapy]
  • salazosulfapyridine/ae [Adverse Drug Reaction]
  • salazosulfapyridine/dt [Drug Therapy]
  • salazosulfapyridine/po [Oral Drug Administration]
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  • skin cancer/si [Side Effect]
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  • time
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  • triamcinolone acetonide/dt [Drug Therapy]
  • triamcinolone acetonide/im [Intramuscular Drug Adm
  • tumor necrosis factor alpha inhibitor/ae [Adverse
  • tumor necrosis factor alpha inhibitor/dt [Drug The
  • tumor necrosis factor alpha inhibitor/pe [Pharmaco

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  • Ding T.

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