Rheumatoid Arthritis

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Rheumatoid Arthritis
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Overview

Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disorder that primarily affects joints. However, it is not limited merely to the joints. It occurs when the body’s own immune system mistakenly begins to attack the joints. This causes inflammation of the joint, making it red, warm, swollen, and painful (hence named as arthritis). What triggers this autoimmune reaction is not known. An external trigger like cigarette smoking, trauma, or infection might play a role.

RA can involve any joint, but it usually starts in the small hand joints. Other joints commonly affected include those of knees, hips, ankles, feet, elbows, neck, and shoulders.

Women are more likely to be affected from RA than men are.


Signs and Symptoms of RA

In addition to joint pain and inflammation, people affected by RA present with the following signs and symptoms:

Articular (related to joint) manifestations

  • Morning stiffness.
  • Deformity.
  • Limitation of movement.

Extra-articular manifestations

  • A general feeling of being unwell.
  • Fatigue.
  • Skin involvement .
    • Rheumatoid nodules.
    • Skin ulceration: Secondary to inflammation of blood vessels (vasculitis) supplying the limbs.
    • Pyoderma gangrenosum: A condition that causes the development of massive, painful sores (ulcers) on the skin, mostly on the legs.
  • Lung involvement.
    • Pleuritis: Inflammation of the covering of the lungs.
    • Pleural effusion: Collection of fluid within the pleura.
  • Hematologic disease.
    • Anemia.
    • Felty's syndrome: A constellation of RA, splenomegaly, and neutropenia.
  • Nerve involvement
    • Carpal tunnel syndrome.

Diagnosis of RA

There is no unique test or sign that is pathognomonic for RA. The patient has rheumatoid arthritis if he or she meets at least four of these seven criteria.


  1. Morning stiffness
    • Morning stiffness in and around the joints.
    • Lasting at least 1 hour prior to maximal improvement.
  2. Arthritis of three or more joint areas.
  3. Arthritis of hand joints.
  4. Symmetrical arthritis
  5. Rheumatoid nodules
  6. Serological markers
    • Serum rheumatoid factor.
    • ACPA – "ACPA" stands for "anti-citrullinated protein antibody.
  7. Radiographic changes typical of rheumatoid arthritis

Treatment

RA leads to deformed joints with restricted movements and functionality. Thus, treating RA is of utmost importance. Analgesics like NSAIDs may ease the pain and inflammation of joints. Steroids and disease-modifying agents ameliorate symptoms and slow the progression of the disease.

FDA Approved Medicines

  • FDA approved infliximab, sold as Remicade, manufactured by Centocor Ortho Biotech as intravenous infusion for the treatment of rheumatoid arthritis ( Rheumatoid Arthritis ) in year 2002.
  • FDA approved ibuprofen and famotidine, sold as Duexis, manufactured by Horizon Pharma for the relief of rheumatoid arthritis and osteoarthritis and prevention of gastric ulcers ( Osteoarthritis | Rheumatoid Arthritis | Stomach Ulcer ) in year 2011.
  • FDA approved adalimumab, sold as Humira, manufactured by Abbott Laboratories for the treatment of moderately to severely active rheumatoid arthritis ( Rheumatoid Arthritis ) in year 2002.
  • FDA approved tofacitinib, sold as Xeljanz, manufactured by Pfizer for the treatment of moderately to severely active rheumatoid arthritis ( Rheumatoid Arthritis ) in year 2012.
  • FDA approved naproxen sodium, sold as Naprelan, manufactured by Elan Pharmaceuticals, Wyeth for the treatment of osteoarthritis and rheumatoid arthritis ( Osteoarthritis | Rheumatoid Arthritis ) in year 1996.
  • FDA approved rofecoxib, sold as Vioxx, manufactured by Merck for the treatment of rheumatoid arthritis ( Rheumatoid Arthritis ) in year 2004.
  • FDA approved sulfasalazine, sold as Azulfidine EN-tabs Tablets, manufactured by Pharmacia & Upjohn for the treatment of rheumatoid arthritis ( Rheumatoid Arthritis ) in year 1996.
  • FDA approved etodolac, sold as Lodine, manufactured by Wyeth for the treatment of rheumatoid arthritis ( Rheumatoid Arthritis ) in year 1996.
  • FDA approved golimumab, sold as Simponi, manufactured by Centocor Ortho Biotech for the treatment of rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis ( Ankylosing Spondylitis | Psoriatic Arthritis | Rheumatoid Arthritis ) in year 2009.