title: Rheumatoid arthritis.
abstract: Rheumatoid arthritis is characterised by persistent synovitis, systemic inflammation, and autoantibodies (particularly to rheumatoid factor and citrullinated peptide). 50% of the risk for development of rheumatoid arthritis is attributable to genetic factors. Smoking is the main environmental risk. In industrialised countries, rheumatoid arthritis affects 0·5-1·0% of adults, with 5-50 per 100 000 new cases annually. The disorder is most typical in women and elderly people. Uncontrolled active rheumatoid arthritis causes joint damage, disability, decreased quality of life, and cardiovascular and other comorbidities. Disease-modifying antirheumatic drugs (DMARDs), the key therapeutic agents, reduce synovitis and systemic inflammation and improve function. The leading DMARD is methotrexate, which can be combined with other drugs of this type. Biological agents are used when arthritis is uncontrolled or toxic effects arise with DMARDs. Tumour necrosis factor inhibitors were the first biological agents, followed by abatacept, rituximab, and tocilizumab. Infections and high costs restrict prescription of biological agents. Long-term remission induced by intensive, short-term treatment selected by biomarker profiles is the ultimate goal.
authors.affiliation: Department of Rheumatology, King's College London School of Medicine, London, UK. d.scott@nhs.net
authors.forename: David L
authors.initials: DL
authors.lastname: Scott
authors.forename: Frederick
authors.initials: F
authors.lastname: Wolfe
authors.forename: Tom W J
authors.initials: TW
authors.lastname: Huizinga
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001171:Arthritis, Juvenile; D001172:Arthritis, Rheumatoid / Q000145:classification / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000235:genetics / Q000276:immunology / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D001323:Autoantibodies / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002356:Cartilage / Q000473:pathology; D003362:Cost-Benefit Analysis; D019091:Critical Pathways; D005347:Fibroblasts / Q000473:pathology; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D007249:Inflammation / Q000503:physiopathology; D012217:Rheumatoid Factor / Q000097:blood*; D012307:Risk Factors; D016706:Still's Disease, Adult-Onset; D013583:Synovial Membrane / Q000473:pathology*; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D018501:Antirheumatic Agents; D001323:Autoantibodies; D015415:Biomarkers; D005938:Glucocorticoids; D014409:Tumor Necrosis Factor-alpha; D012217:Rheumatoid Factor