Diagnosis and Management of Rheumatoid Arthritis

Abstract

We read with interest the article “Rheumatoid Arthritis: Diagnosis and Management” in the Office Management Section in your recent issue.1Majithia V. Geraci S.A. Rheumatoid arthritis: diagnosis and management.Am J Med. 2007; 120: 936-939Abstract Full Text Full Text PDF PubMed Scopus (325) Google Scholar Atrophy of muscles near the involved joints is a “late” phenomenon, if at all, in rheumatoid arthritis. Thus, it should not be used for diagnostic purposes. The whole idea behind the “inverted pyramid-paradigm approach” to rheumatoid arthritis is to avoid a state of functio laesa! Under “Key Points: Diagnosis and Initial Management Decisions,” the authors are probably trying to say “metacarpal-phalangeal,” and “metatarsal-phalangeal” joints instead of “metacarpal or metatarsal” joints (metacarpals and metatarsals are “bones,” not joints). The target dose of methotrexate has been mentioned as 15 mg per week, whereas the standard dose is 20 to 25 mg per week.2Van der Bijl A.E. Goekoop-Ruiterman Y.P. de Vries-Bouwstra J.K. et al.Infliximab and methotrexate as induction therapy in patients with early rheumatoid arthritis.Arthritis Rheum. 2007; 56: 2129-2134Crossref PubMed Scopus (103) Google Scholar The following is in reference to Table 3:•The total daily dosage of azathioprine can be increased to 2.5 mg/kg/d administered orally (not 150 mg), and infliximab can be increased to 5 mg/kg intravenously infused every 4 weeks.2Van der Bijl A.E. Goekoop-Ruiterman Y.P. de Vries-Bouwstra J.K. et al.Infliximab and methotrexate as induction therapy in patients with early rheumatoid arthritis.Arthritis Rheum. 2007; 56: 2129-2134Crossref PubMed Scopus (103) Google Scholar•The route of administration of abatacept, infliximab, and rituximab (intravenous infusion), and leflunomide, minocycline, and sulfasalazine (oral) has not been mentioned.•Per the authors, if leflunomide requires serologic testing for hepatitis B and C virus infection in high-risk patients, why not methotrexate? It has a potential for hepatotoxicity as well. Because constant and seminal progress is being made in the field of rheumatoid arthritis, it might be significant to discuss the emerging concepts of “early rheumatoid arthritis,” “therapeutic window of opportunity,” and the possibility of incorporating anti–cyclic-citrullinated peptide antibodies into the diagnostic algorithm for rheumatoid arthritis.3Cush J.J. Early rheumatoid arthritis—is there a window of opportunity?.J Rheumatol Suppl. 2007; 80: 1-7PubMed Google Scholar, 4Fukuda T. Window of opportunity for treatment of rheumatoid arthritis.Nippon Rinsho. 2007; 65: 1276-1281PubMed Google Scholar, 5Finckh A. Liang M.H. Anti-cyclic citrullinated peptide antibodies in the diagnosis of rheumatoid arthritis: bayes clears the haze.Ann Intern Med. 2007; 146: 816-817Crossref PubMed Scopus (15) Google Scholar The ReplyThe American Journal of MedicineVol. 121Issue 6PreviewWe thank Kaushik et al for their input regarding our review article on the office management of rheumatoid arthritis (RA) and appreciate their comments. We apologize for the typographic errors in the article and would like to correct those. Under the “Key Points: Diagnosis and Management,” we did want to say metacarpophalangeal and metatarsophalangeal joints and the route of administration of various drugs in Table 3 was inadvertently left out, as correctly pointed out by the authors. A corrected version of Table 3 is attached here. Full-Text PDF