What is a rheumatoid condition that affects soft tissue?

From the Guidelines

Rheumatoid arthritis is a rheumatoid condition that affects not only the joints but also the soft tissues, causing symmetric polyarthritis with joint swelling, morning stiffness, and potentially leading to extra-articular disease manifestations such as interstitial lung disease, vasculitis, and inflammatory eye disease. This condition can develop in persons of any age, with a typical age at onset of about 55 years, and its prevalence increases considerably with age, affecting approximately 6% of the white population older than 65 years 1. The clinical features of rheumatoid arthritis include symmetric polyarthritis with joint swelling, especially of the hands and feet, although any of the appendicular joints may become involved. Patients with rheumatoid arthritis experience morning stiffness that lasts 1 hour or longer, and characteristic subcutaneous nodules are markers of severe disease 1.

Some key points to consider in the management of rheumatoid arthritis include:

• The importance of early and aggressive management to improve patient functioning and quality of life, reduce comorbid conditions, and enhance survival 1
• The use of biologic response-modifying drugs designed to inhibit the inflammatory process, which have greatly altered the approach to managing this disease 1
• The potential for extra-articular disease manifestations, which can be severe and affect various organs, including the lungs, blood vessels, and eyes 1
• The impact of rheumatoid arthritis on daily life, including the potential for work disability and shortened life expectancy, especially in patients with extra-articular disease and those who develop serious treatment-related adverse effects 1

The management of rheumatoid arthritis should prioritize a multimodal approach, including medications, non-pharmacological treatments, and lifestyle modifications, to improve patient outcomes and reduce the risk of complications. This approach should be individualized to each patient's needs and should take into account the potential benefits and risks of different treatments, as well as the patient's preferences and values 1.

From the FDA Drug Label

The mechanism of action in rheumatoid arthritis is unknown; it may affect immune function. In patients with rheumatoid arthritis, effects of methotrexate on articular swelling and tenderness can be seen as early as 3 to 6 weeks Although methotrexate clearly ameliorates symptoms of inflammation (pain, swelling, stiffness), there is no evidence that it induces remission of rheumatoid arthritis nor has a beneficial effect been demonstrated on bone erosions and other radiologic changes which result in impaired joint use, functional disability, and deformity

The rheumatoid condition that affects soft tissue is Rheumatoid Arthritis. It affects the soft tissues, such as the synovium, a type of connective tissue that lines the joints, and causes symptoms like pain, swelling, and stiffness. Methotrexate is used to treat rheumatoid arthritis and can ameliorate symptoms of inflammation, but its exact mechanism of action is unknown 2.

• Key points:
  • Rheumatoid arthritis affects soft tissues like the synovium.
  • Methotrexate is used to treat rheumatoid arthritis.
  • Methotrexate's mechanism of action in rheumatoid arthritis is unknown.
  • Methotrexate can ameliorate symptoms of inflammation, but does not induce remission or prevent bone erosions.

From the Research

Rheumatoid Arthritis Overview

• Rheumatoid arthritis is a common autoimmune, destructive, inflammatory arthritis in adults, affecting soft tissue and causing substantial morbidity and mortality 3, 4, 5.
• The disease can impact organs other than the joints, including lungs, skin, and eyes 5.

Diagnosis and Treatment

• Rheumatoid arthritis should be considered if there is at least one joint with definite swelling that is not better explained by another disease, and the presence of a rheumatoid factor and/or anti-citrullinated protein antibody, elevated C-reactive protein level, or elevated erythrocyte sedimentation rate is consistent with a diagnosis of rheumatoid arthritis 5.
• Effective treatments include oral conventional synthetic disease-modifying antirheumatic drugs (DMARDs; eg, methotrexate), injectable biologic DMARDs, and targeted synthetic DMARDs (oral) 3.
• Methotrexate is typically the first-line agent for rheumatoid arthritis, and additional disease-modifying antirheumatic drugs or biologic agents should be added if disease activity persists 5, 6, 7.

Combination Therapy

• Combination therapy with methotrexate, sulfasalazine, and hydroxychloroquine is more effective than either methotrexate alone or a combination of sulfasalazine and hydroxychloroquine 4.
• Combining disease-modifying antirheumatic drugs (DMARDs) is a widely used therapeutic alternative, and a popular combination is methotrexate plus sulfasalazine 6, 7.
• Triple DMARD therapy is better than various DMARD monotherapy and dual therapy regimens, and methotrexate and hydroxychloroquine may have synergistic anti-inflammatory properties 6.