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Evaluation and medical management of end-stage rheumatoid arthritis

Simon M Helfgott, MD
Section Editor
Ravinder N Maini, BA, MB BChir, FRCP, FMedSci, FRS
Deputy Editor
Paul L Romain, MD


End-stage rheumatoid arthritis (RA) is an advanced stage of disease in which there is severe joint damage and destruction in the absence of ongoing inflammation. Despite the availability of methotrexate and other nonbiologic disease-modifying antirheumatic drugs (DMARDs), as well as biologic DMARDs and kinase inhibitors, some patients with RA do not adequately respond to therapy [1,2]. The joints of such patients may eventually be destroyed by a variety of mechanisms, resulting in end-stage RA and often requiring joint arthroplasty to improve or restore function.

The evaluation and management of patients with apparent end-stage disease requires:

Assessment of whether residual disease activity is present that may respond to adjustment of the drug therapies

Identification of factors other than articular inflammation that may be contributing to the clinical state and may require interventions distinct from antirheumatic drug therapy

Recognition and referral of patients who may benefit from rehabilitative or orthopaedic interventions


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Literature review current through: Jul 2017. | This topic last updated: Dec 16, 2016.
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