Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

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

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Dec 16, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.