Disease primer: Rheumatiod Arthritis (RA)

An auto-immune systemic disease. Requires life-long treatment. Individual patients with RA appear to have different pathogenic mechanisms, due to different treatment response. Two major “types”: seropositive and seronegative, with seropositive presenting more severe symptoms.

Typical patient

  • Age 30-70
  • 70% women
  • Symmetrical polyarthritis of hands and feet.
  • Common to have morning stiffness lasting more than 30 minutes.

Risk factors

  • First-degree relative with RA
  • Gene HLA-DR
  • Smoking
  • Overweight
  • Infections

Clinical diagnostics

  • Number and location of affected joints
  • Duration of disease >= 6 weeks
  • Acute-phase reactants
  • X-ray for bone erosion
  • Serum samples to determine seropositive/seronegative
    • Rheumatiod factor (RF)
    • Anti-citrullinated protein antibodies (ACPAs)

Treatment

  • DMARDs (Disease-Modifying Antirheumatic Drugs)
    • Conventional
      • Methotrexate (folate antagonist)
        • Typical treatment, 33% response rate.
      • Leflunomide
      • Sulfasalazine
      • Hydroxychloroquine
    • Biologic (either alone or combo with conventionals)
      • Anti TNF-alpha
        • Adalimumab
        • Certolizumab
        • Etanercept
        • Golimumab
        • Infliximab
      • Anti IL6
        • Tocilizumab
        • Sarilumab
      • B-cell depletion
        • Rituximab
      • T-Cell co-stimulatory inhibitor
        • Abatacept
    • Targeted synthetic
      • JAK inhibitor
        • Tofacitinib
        • Baricitinib
        • Upadacitinib

References

  • https://www.nejm.org/doi/full/10.1056/NEJMra2103726
  • https://www.youtube.com/watch?v=e_NZk8nFSPA