Rheumatoid arthritis

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Última revisão: 22 Jul 2025

Última atualização: 07 Jan 2025

Rheumatoid arthritis (RA) is a chronic, erosive arthritis that requires early and aggressive treatment.

Diagnosed clinically. Laboratory and radiographic testing provide prognostic information more often than diagnostic information.

Early and aggressive treatment with disease-modifying antirheumatic drugs (DMARDs), potentially combined with a biologic agent or a targeted synthetic DMARD, is recommended.

Disease activity scores (e.g., 28-joint count version of disease activity score [DAS28], clinical disease activity index [CDAI], simplified disease activity index [SDAI], routine assessment patient index data [RAPID3]) are used routinely to provide optimum care for RA patients.

Definição

RA is a chronic inflammatory condition affecting around 1% of the population, making it the most common inflammatory arthritis seen by physicians.[1][2][3][4] It primarily affects the small joints of the hands and feet and, if not treated aggressively, can be a major cause of work loss, decreased quality of life, need for joint replacement surgery, and mortality.[5] RA is a clinical diagnosis; laboratory and radiographic tests help to confirm the diagnosis and provide useful prognostic information.

História e exame físico

Principais fatores diagnósticos

active symmetric arthritis lasting >6 weeks
age 50 to 55 years
female sex
joint pain
joint swelling

Detalhes completos

Outros fatores diagnósticos

morning stiffness
swan neck deformity
Boutonniere deformity
ulnar deviation
rheumatoid nodules
vasculitic lesions
pleuritic chest pain
scleritis and/or uveitis

Detalhes completos

Fatores de risco

genetic predisposition
smoking
overweight or obesity
infection

Detalhes completos

Диагностические исследования

Исследования, которые показаны в первую очередь

rheumatoid factor (RF)
anticyclic citrullinated peptide (anti-CCP) antibody
radiographs
ultrasonography

Полная информация

Исследования, проведение которых нужно рассмотреть

disease activity score(s)
MRI

Полная информация

Алгоритм лечения

Острый

mild disease activity at initial presentation: not pregnant or planning pregnancy

moderate-to-severe disease activity at initial presentation: not pregnant or planning pregnancy

pregnant or planning pregnancy

ПРОДОЛЖЕНИЕ

failure to reach low disease activity after 3 months of therapy: not pregnant or planning pregnancy

Составители

Авторы

Yusuf Yazici, MD

Clinical Associate Professor of Medicine

New York University School of Medicine

New York

Раскрытие информации

YY receives research support from BMS and Amgen; he has consulted for Amgen, BMS, Hemay, Chugai, and Sanofi.

Рецензенты

Joshua F. Baker, MD, MSCE

Associate Professor of Medicine and Epidemiology

University of Pennsylvania

Pennsylvania

Раскрытие информации

JFB has received consulting fees from Bristol-Myers Squibb, Pfizer, Cumberland Pharma, and CorEvitas.

Список литературы

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Основные статьи

Fraenkel L, Bathon JM, England BR, et al. 2021 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Rheumatol. 2021 Jul;73(7):1108-23.Полный текст Аннотация

National Institute for Health and Care Excellence. Rheumatoid arthritis in adults: management. Oct 2020 [internet publication].Полный текст

Smolen JS, Landewé RBM, Bergstra SA, eta al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update. Ann Rheum Dis. 2023 Jan;82(1):3-18 Epub 2022 Nov 10.Полный текст Аннотация

Статьи, указанные как источники

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Отличия
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Больше Отличия
Рекомендации
- 2023 American College of Rheumatology (ACR) guideline for the screening and monitoring of interstitial lung disease in people with systemic autoimmune rheumatic disease
- Guideline for vaccinations in patients with rheumatic and musculoskeletal diseases
Больше Рекомендации
Лифлеты для пациента
Rheumatoid arthritis
Rheumatoid arthritis: questions to ask your doctor
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Rheumatoid arthritis

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Диагностические исследования

Исследования, которые показаны в первую очередь

Исследования, проведение которых нужно рассмотреть

Алгоритм лечения

mild disease activity at initial presentation: not pregnant or planning pregnancy

moderate-to-severe disease activity at initial presentation: not pregnant or planning pregnancy

pregnant or planning pregnancy

failure to reach low disease activity after 3 months of therapy: not pregnant or planning pregnancy

Составители

Авторы

Yusuf Yazici, MD

Раскрытие информации

Рецензенты

Joshua F. Baker, MD, MSCE

Раскрытие информации

Список литературы

Основные статьи

Статьи, указанные как источники

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Отличия

Рекомендации

Лифлеты для пациента

Войдите в учетную запись или оформите подписку, чтобы получить полноценный доступ к BMJ Best Practice

Войдите в учетную запись или оформите подписку, чтобы получить полноценный доступ к BMJ Best Practice

Войдите в учетную запись, чтобы получить полноценный доступ к BMJ Best Practice