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
- Methotrexate (folate antagonist)
- 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
- Anti TNF-alpha
- Targeted synthetic
- JAK inhibitor
- Tofacitinib
- Baricitinib
- Upadacitinib
- JAK inhibitor
- Conventional
References
- https://www.nejm.org/doi/full/10.1056/NEJMra2103726
- https://www.youtube.com/watch?v=e_NZk8nFSPA