Briefly describe rheumatoid arthritis and its treatment.
Rheumatoid arthritis (RA) is an autoimmune
disease affecting primarily women and is present in up to 1% of the population.
This chronic and systemic inflammatory condi-tion targets mainly the synovial
tissue of the joints. Diagnostic criteria which are indicative of RA, though
not specific for it, include morning stiffness, arthritis of three or more
joints, arthritis of the hand joints, symmetric distribution, rheumatoid
nodules, elevated levels of rheuma-toid factor, and radiographic changes.
Patients may develop cricoarytenoid arthritis which may make tracheal
intubation difficult. Extra-articular manifestations of the disease can present
in the heart, lungs, kidneys, and in the blood.
While the diagnosis of RA can be somewhat
elusive, it has been shown that the prompt initiation of therapy can delay the
course of the disease. Medications used to treat RA are generally divided into
three main categories: disease-modifying anti-rheumatic drugs (DMARDs),
corticosteroids, and nonsteroidal anti-inflammatory drugs (NSAIDs). Recently
the use of Cox-2 inhibitors has also been instituted by many physicians.
DMARDs, as the epithet indicates, alter the
course of RA. There are many different drugs in this category, which include
methotrexate, sulfasalazine, azathioprine, and cyclosporine. Corticosteroids,
which alter the inflammatory response of RA, are used arbitrarily by different
physicians. Corticosteroids may be prescribed in a low dose for chronic use or
as a steroid taper for exacerbations. NSAIDs are commonly prescribed to provide
relief from pain and stiff-ness; however, they do not alter the course of the