Despite the availability of methotrexate (MTX), other disease-modifying antirheumatic drugs (DMARDs), and biologic agents, some patients with rheumatoid arthritis (RA) fail to adequately respond to therapy . Via a variety of mechanisms, the joints of such patients may eventually be destroyed, requiring joint arthroplasty to restore function.
This stage of the disease, termed “end-stage RA,” is characterized clinically by the following features:
- Pain occurring with minimal activity and at rest
- Periarticular muscle atrophy and weakness
- A significant decline in functional status resulting in disability
- Radiographic evidence of articular damage (eg, severe loss of joint space and/or erosions)
This topic will review the evaluation and medical management of patients with end-stage RA. The medical management of patients with active disease and the surgical management of those with end-stage RA are discussed in detail separately. (See "General principles of management of rheumatoid arthritis in adults" and "Total joint replacement for severe rheumatoid arthritis".)
The progression of disease which culminates in end-stage RA usually occurs over years to decades. The causes of joint destruction include any combination of the following: