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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.

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  • Authors+Show Affiliations

    ,

    Department of Rheumatology, King's College London School of Medicine, London, UK. d.scott@nhs.net

    ,

    Source

    Lancet (London, England) 376:9746 2010 Sep 25 pg 1094-108

    MeSH

    Antirheumatic Agents
    Arthritis, Juvenile
    Arthritis, Rheumatoid
    Autoantibodies
    Biomarkers
    Cartilage
    Cost-Benefit Analysis
    Critical Pathways
    Fibroblasts
    Glucocorticoids
    Humans
    Incidence
    Inflammation
    Rheumatoid Factor
    Risk Factors
    Still's Disease, Adult-Onset
    Synovial Membrane
    Treatment Outcome
    Tumor Necrosis Factor-alpha

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't
    Review

    Language

    eng

    PubMed ID

    20870100

    Citation

    Scott, David L., et al. "Rheumatoid Arthritis." Lancet (London, England), vol. 376, no. 9746, 2010, pp. 1094-108.
    Scott DL, Wolfe F, Huizinga TW. Rheumatoid arthritis. Lancet. 2010;376(9746):1094-108.
    Scott, D. L., Wolfe, F., & Huizinga, T. W. (2010). Rheumatoid arthritis. Lancet (London, England), 376(9746), pp. 1094-108. doi:10.1016/S0140-6736(10)60826-4.
    Scott DL, Wolfe F, Huizinga TW. Rheumatoid Arthritis. Lancet. 2010 Sep 25;376(9746):1094-108. PubMed PMID: 20870100.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Rheumatoid arthritis. AU - Scott,David L, AU - Wolfe,Frederick, AU - Huizinga,Tom W J, PY - 2010/9/28/entrez PY - 2010/9/28/pubmed PY - 2010/10/15/medline SP - 1094 EP - 108 JF - Lancet (London, England) JO - Lancet VL - 376 IS - 9746 N2 - 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. SN - 1474-547X UR - https://www.unboundmedicine.com/medline/citation/20870100/full_citation L2 - https://linkinghub.elsevier.com/retrieve/pii/S0140-6736(10)60826-4 DB - PRIME DP - Unbound Medicine ER -