Pharmacologic Management of Rheumatoid Arthritis

Abstract

Rheumatoid arthritis (RA) is an autoimmune, systemic inflammatory disease whose hallmark is symmetrical, polyarticular joint involvement. There is characteristic synovial membrane inflammation and proliferation with potential joint and periarticular structure destruction resulting in pain, joint destruction, deformity, and loss of function. Systemic symptoms can occur in RA; they can sometimes antedate evident joint manifestations and include fatigue, weakness, low-grade fever, and generalized malaise. RA occurs predominantly in women, with a peak onset between the fourth and sixth decades of life. All ethnic groups can be affected, although Native American populations tend to have higher rates of prevalence while Asian populations seem to have lower rates. The prevalence of RA in the United States has been estimated at around 1% [1]. RA results in increased morbidity and mortality. The increased morbidity includes significantly increased rates of myocardial infarction, stroke, infection, and lymphoma. It has also been estimated that RA results in mortality rates up to 27% higher than in the general population [2]. Life expectancy can be significantly reduced in patients with RA, although estimates vary widely [3]. The medical and societal costs of RAin the United States have been estimated at $9 billion per year [4]. These estimates fail to account for intangible costs, such as impact on the family as daily life is modified to accommodate the needs of the person with RA. The lifetime costs for a patient with RA have been said to rival those of entities such as stroke or cardiovascular disease [5].