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Monitoring the Patient With Rheumatoid Arthritis for Disease Progression
The Case: A 45-year-old woman was diagnosed with rheumatoid arthritis 18 months ago. At that time, she had positive anti-cyclic cirullinated peptide antibodies and incipient erosions of both metacarpophalangeal joints. Symptomatically she responded with mildly decreased pain and stiffness improvement on methotrexate therapy and was given adalimumab 6 months later with complete resolution of pain, swelling, fatigue and morning stiffness. Upon presentation to your office today for a second opinion regarding continued treatment, her physical examination, sedimentation rate, thyroid studies and C-reactive protein are normal.
Key Supporting Information
Image: Codario RA
Rheumatoid arthritis (RA) is a progressive and painful systemic inflammatory disease that preferentially attacks the synovium of the joint. It affects approximately 1% of adults in the United States. Left unchecked, RA leads to joint destruction, debility and deformity. The systemic inflammation of RA also is associated with a variety of extra-articular manifestations to the skin, eye, lung, renal, nervous, gastrointestinal and cardiovascular systems. Although symptomatic control of the disease can be achieved, erosions may continue to progress. Repeat radiographic studies and/or ultrasound can assess the status of these changes (Figure). Should there be further radiographic progression, the therapeutic regimen may need to be adjusted despite the symptomatic improvement.
The 2010 ACR/EULAR classification criteria for RA state that patients with a score of factors listed below 6 establishes the diagnosis.
- References:
- Cojocaru M et al. Mædica 2010;5(4):286-291.
- Gibofsky A. Am. J. Manag. Care 2014;20(7 Suppl):s128-145.
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Learning Objectives
Upon successful completion of this educational activity, participants should be better able to evaluate patients for the signs and symptoms of rheumatoid arthritis and identify effective therapies for this disease.
Overview
Author(s)/Faculty: Ronald A. Codario, MD, FACP, FNLA, CCMEP
Source: Healio Rheumatology Education Lab
Type: Monograph
Articles/Items: 4
Release Date: 4/15/2015
Expiration Date: 4/15/2016
Credit Type: CME
Number of Credits: 0.25
Cost: Free
Provider: Vindico Medical Education
CME Information
Provider Statement: This continuing medical education activity is provided by Vindico Medical Education.
Support Statement: No commercial support for this activity.
Target Audience: This activity is designed for this activity is rheumatologists and other health care professionals involved in the treatment of patients with rheumatological disorders.