Counseling Points - October 2007 - (Page 13)

CP Counseling Points Rheumatoid Arthritis: Epidemiology, Symptomatology, and Natural History of the Disease Process • Rheumatoid arthritis (RA) is both a rheumatic and an autoimmune disease. • RA can affect many tissues throughout the body, but the synovial membranes of the diarthrodial joints are usually the most severely affected. • The onset of RA begins insidiously and is characterized by anorexia, generalized weakness, and vague musculoskeletal symptoms. Swelling, tenderness, warmth, and limitation of motion occur as a result of synovial inflammation. • Spontaneous remission is rare and after 20 years of having the disease, 80% or more of patients will have some disability or deformity. • Although RA can develop at any age, it is most likely to occur between the ages of 35 and 50. • On average, individuals with RA have two or more co-morbidities, such as cardiovascular disease, depression, and chronic lung disease. • Although a specific cause for RA has yet to be determined, it is thought that the disease is generated from the combination of genetic susceptibility and exposure to environmental risk factors. • The main proinflammatory cytokines involved in the RA disease process are TNF-α, IL-1, and IL-6. • The clinical course of RA follows an onset that may be acute, gradual, or subacute. Early in the disease, there are no criteria that can predict the resolution or progression of RA in a specific patient. • No single laboratory test, histologic finding, or radiographic characteristic confirms a diagnosis of RA. Rather, clinicians use a number of findings over a period of time to determine if the disease is present. • Medications that are used to treat RA are divided into three primary classes: nonsteroidal antiinflammatory drugs (NSAIDs), corticosteroids, and disease-modifying antirheumatic drugs (DMARDs), which include both synthetic and biologic agents. • NSAIDs have anti-inflammatory and analgesic properties and provide partial relief of pain and stiffness, but they have not been demonstrated to alter disease course or slow progression of RA. • For long-term RA control, steroids should be used in low dosages, such as ≤10 mg of prednisone per day. • DMARDs are defined as medications that slow or stop the progression of disease. • Biologic DMARDs have novel mechanisms of action and a more rapid onset of action than conventional DMARDs. ™ 13 OCTOBER 2007

Table of Contents Feed for the Digital Edition of Counseling Points - October 2007

Counseling Points - October 2007 Welcome Introduction Overview of RA RA Morbidity and Mortality RA Costs and Quality of Life RA Risk Factors Pathophysiology of RA Diagnosis and Natural History of RA Diagnostic Tests and Radiography Natural History and Progression of RA Disease Management Treatment Strategies Summary Continuing Education Posttest Evaluation Form

Counseling Points - October 2007

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