From the Guidelines
Rheumatoid arthritis (RA) is an autoimmune disease that requires early diagnosis and aggressive treatment to prevent joint damage and disability, with the primary goal of achieving remission or low disease activity through a combination of medications and lifestyle changes, as recommended by the 2016 update of the EULAR recommendations for the management of early arthritis 1.
Cause and Risk Factors
The exact cause of RA is unknown, but it involves the immune system attacking the body's own tissues. Risk factors include:
- Genetics
- Female gender
- Age (30-60 years)
- Smoking
- Obesity
Preventive Measures
Preventive measures include:
- Quitting smoking
- Maintaining a healthy weight
- Regular exercise
- Balanced diet rich in omega-3 fatty acids
Signs and Symptoms
Signs and symptoms of RA include:
- Joint pain, swelling, and stiffness (especially in hands and feet)
- Fatigue
- Low-grade fever
- Loss of appetite
- Symmetrical joint involvement
Treatment
Treatment options for RA include:
- Disease-modifying antirheumatic drugs (DMARDs):
- Methotrexate: 7.5-25 mg weekly
- Hydroxychloroquine: 200-400 mg daily
- Sulfasalazine: 1-3 g daily
- Biologics (if DMARDs are ineffective):
- TNF inhibitors (e.g., adalimumab, etanercept)
- IL-6 inhibitors (e.g., tocilizumab)
- Pain management:
- NSAIDs: ibuprofen 400-800 mg 3-4 times daily or naproxen 250-500 mg twice daily
- Low-dose corticosteroids: prednisone 5-10 mg daily (short-term use)
- Physical and occupational therapy
- Lifestyle modifications:
- Regular exercise
- Stress management
- Joint protection techniques
According to the 2017 EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs, the treatment target should be a state of clinical remission or low disease activity, and treatment should be adjusted at least every 3 months until the desired target is reached 1. The patient version of the international recommendations also emphasizes the importance of shared decision-making between the patient and rheumatologist, and the need for regular monitoring and adjustment of treatment plans to achieve the desired treatment target 1.
From the FDA Drug Label
Enbrel is indicated for reducing signs and symptoms, inducing major clinical response, inhibiting the progression of structural damage, and improving physical function in patients with moderately to severely active rheumatoid arthritis (RA). Methotrexate can suppress hematopoiesis and cause anemia, aplastic anemia, pancytopenia, leukopenia, neutropenia, and/or thrombocytopenia.
The causes of Rheumatoid Arthritis (RA) are not directly stated in the provided drug labels. The risk factors for RA are not directly stated in the provided drug labels, but it is mentioned that age at first use of methotrexate and duration of therapy have been reported as risk factors for hepatotoxicity in rheumatoid arthritis patients. Preventive measures for RA are not directly stated in the provided drug labels. The signs and symptoms of RA are not directly stated in the provided drug labels, but it is mentioned that Enbrel is indicated for reducing signs and symptoms of RA. Treatment options for RA include Enbrel, which can be initiated in combination with methotrexate (MTX) or used alone 2, and methotrexate, which can be used to treat rheumatoid arthritis 3.
From the Research
Causes and Risk Factors
- Rheumatoid arthritis (RA) is an autoimmune disease characterized by synovial inflammation of joints in response to autoimmune disorders 4
- The development of RA involves a complex interplay of cellular factors, such as osteoclasts, synovial fibroblasts, T cells, and B cells, as well as soluble factors like interleukin-1 (IL-1), IL-6, IL-17, and tumor necrosis factor-α (TNF-α) 4
- RA is a heterogeneous disorder caused by an abnormal autoimmune response triggered by the complex interactions of genetic and environmental factors 5
- Emerging evidence indicates that RA patients often experience a preclinical stage characterized by immunological and inflammatory changes before developing the disease 6
Preventive Measures
- There are ongoing efforts to predict the transition from the preclinical phase to clinical RA and to prevent the onset of RA in individuals at risk 6
- Early diagnosis and aggressive treatment have markedly improved both the management and long-term prognosis of RA 7
Signs and Symptoms
- The presenting symptoms of musculoskeletal pain, swelling, and stiffness are common in clinical practice 7
- Patients with RA are at greater risk for serious infection, respiratory disease, osteoporosis, cardiovascular disease, cancer, and mortality than the general population 7
- The development of joint swelling is traditionally regarded as the starting point of the disease 6
Treatment Options
- The primary drugs used to ease patient symptoms are disease-modifying antirheumatic drugs (DMARDs) 4
- However, traditional DMARDs can cause serious side effects, such as high blood pressure and stomach ulcers 4
- Recent discoveries on the pathogenesis of RA have led to various new kinds of drugs or therapeutic strategies, including biologics, small molecule agents, and targeted therapies 4, 8
- Promising targeted therapies under clinical or preclinical trials include epigenetic and metabolic regulators 8
- Prospects on precision medicine based on synovial biopsy or RNA-sequencing and cell therapies of mesenchymal stem cells or chimeric antigen receptor T-cell are also being explored 8