Evaluation and medical management of end-stage rheumatoid arthritis
- Simon M Helfgott, MD
Simon M Helfgott, MD
- Section Editor — General Rheumatology and Related Topics
- Associate Professor of Medicine
- Harvard Medical School
- Section Editor
- Ravinder N Maini, BA, MB BChir, FRCP, FMedSci, FRS
Ravinder N Maini, BA, MB BChir, FRCP, FMedSci, FRS
- Section Editor — Rheumatoid Arthritis
- Emeritus Professor of Rheumatology, Imperial College London
- Visiting Professor, Oxford University
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 interventionsTo 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:
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- ETIOLOGIC FACTORS
- CLINICAL MANIFESTATIONS
- Physical findings
- Laboratory findings
- Imaging abnormalities
- EVALUATION OF PATIENTS WITH END-STAGE DISEASE
- History and physical examination
- Laboratory, imaging, and other studies
- Disease activity present or suspected
- - Patients currently receiving anti-rheumatic drug therapy
- - Patients NOT currently receiving anti-rheumatic drug therapy
- Disease activity absent
- - Chronic pain management
- - Surgical management
- Rehabilitation therapies
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS