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PharmacotherapyFirst: A Multimedia Learning Resource

Quick Facts

Overview

  • 1. Wasserman AM. Diagnosis and management of rheumatoid arthritis. Am Fam Physician. 2011;84(11):1245–1252. MedlineGoogle Scholar,
  • 2. Stanaszek WF, Carlstedt BC. Rheumatoid arthritis: Pathophysiology. J Pharm Pract. 1999;12(4):282–289. CrossrefGoogle Scholar,
  • 3. Gibofsky A. Epidemiology, pathophysiology, and diagnosis of rheumatoid arthritis: A synopsis. Am J Manag Care. 2014;20:S128-S135. MedlineGoogle Scholar,
  • 4. Saag KG, Teng GG, Patkar NM, et al. American College of Rheumatology 2008 recommendations for the use of nonbiologic and biologic disease-modifying antirheumatic drugs in rheumatoid arthritis. Arthritis Rheum. 2008;59(6):762–784. Crossref, MedlineGoogle Scholar,
  • 5. Singh JA, Saag KG, Bridges SL Jr, et al. 2015 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Care Res. 2015;68(1):1–25. CrossrefGoogle Scholar,

Guidelines and Landmark Trials

  • 1. Arnett FC, Edworthy SM, Bloch DA, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1998;31(3):315–324. CrossrefGoogle Scholar,
  • 2. Aletaha D, Neogi T, Silman AJ, et al. 2010 rheumatoid arthritis classification criteria: An American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum. 2010;62(9):2569–2581. Crossref, MedlineGoogle Scholar,
  • 3. Anderson J, Caplan L, Yazdany J, et al. Rheumatoid arthritis disease activity measures: American College of Rheumatology recommendations for use in clinical practice. Arthritis Care Res. 2012;64(5):640–647. CrossrefGoogle Scholar,
  • 4. Saag KG, Teng GG, Patkar NM, et al. American College of Rheumatology 2008 recommendations for the use of nonbiologic and biologic disease-modifying antirheumatic drugs in rheumatoid arthritis. Arthritis Rheum. 2008;59(6):762–784. Crossref, MedlineGoogle Scholar,
  • 5. Singh JA, Furst DE, Bharat A, et al. 2012 update of the 2008 American College of Rheumatology recommendations for the use of disease-modifying antirheumatic drugs and biologic agents in the treatment of rheumatoid arthritis. Arthritis Care Res. 2012;64(5):625–639. CrossrefGoogle Scholar,
  • 6. Singh JA, Saag KG, Bridges SL Jr, et al. 2015 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Care Res. 2015;68(1):1–25. CrossrefGoogle Scholar,
  • 7. Smolen JS, Landewé R, Bijlsma J, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann Rheum Dis. 2017;76(6):960–977. Crossref, MedlineGoogle Scholar,
  • 8. Smolen JS, Landewé RBM, Bijlsma JWJ, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update. Ann Rheum Dis. 2020;79:685–600. https://doi.org/10.1136/annrheumdis-2019-216655 Crossref, MedlineGoogle Scholar,
  • 9. 2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases. Arthritis Care Res. 2021;72(4):461–488. https://doi.org/10.1002/acr.24130. Google Scholar,
  • 10. Fraenkel L, Bathon JM, England BR, et al. 2021 American College of Rheumatology Guideline for the Treatment of rheumatoid Arthritis. Arthritis Care Res. 2021;73(7):924–939. https://doi.org/10.1002/acr.24596. CrossrefGoogle Scholar,
  • 11. Genovese MC, Kremer J, Zamani O, et al. Baricitinib in patients with refractory rheumatoid arthritis. N Engl J Med. 2016;374(13):1243–1252. Crossref, MedlineGoogle Scholar,
  • 12. Dougados M, Van Der Heijde D, Chen YC, et al. Baricitinib in patients with inadequate response or intolerance to conventional synthetic DMARDs: Results from the RA-BUILD study. Ann Rheum Dis. 2017;76(1):88–95. Crossref, MedlineGoogle Scholar,
  • 13. Van Der Heijde D, Dougados M, Chen YC, et al. Effects of baricitinib on radiographic progression of structural joint damage at 1 year in patients with rheumatoid arthritis and an inadequate response to conventional synthetic disease-modifying antirheumatic drugs. RMD Open. 2018;4(1):e000662. CrossrefGoogle Scholar,
  • 14. Maini R, St Clair EW, Breedveld F, et al. Infliximab (chimeric anti-tumour necrosis factor α monoclonal antibody) versus placebo in rheumatoid arthritis patients receiving concomitant methotrexate: A randomized phase III trial. ATTRACT Study Group. Lancet. 1999;354(9194):1932–1939. Crossref, MedlineGoogle Scholar,
  • 15. Van Der Heijde D, Klareskog L, Rodriguez-Valverde V, et al.; TEMPO Study Investigators. Comparison of etanercept and methotrexate, alone and combined in the treatment of rheumatoid arthritis: Two-year clinical and radiographic results from the TEMPO study, a double-blind randomized trial. Arthritis Rheum. 2006;54(4):1063–1074. Crossref, MedlineGoogle Scholar,
  • 16. Furst DE, Schiff MH, Fleischmann RM, et al. Adalimumab, a fully human anti-tumor necrosis factor-alpha monoclonal antibody, and concomitant standard antirheumatic therapy for the treatment of rheumatoid arthritis: Results of STAR (Safety Trial of Adalimumab in Rheumatoid Arthritis). J Rheumatol. 2003;30(12):2563–2571. MedlineGoogle Scholar,
  • 17. Burmester GR, Lin Y, Patel R, et al. Efficacy and safety of sarilumab monotherapy versus adalimumab monotherapy for the treatment of patients with active rheumatoid arthritis (MONARCH): A randomised, double-blind, parallel-group phase III trial. Ann Rheum Dis. 2016;76(5):840–847. Crossref, MedlineGoogle Scholar,
  • 18. Fleischmann R, Van Adelsberg J, Lin Y, et al. Sarilumab and nonbiologic disease-modifying antirheumatic drugs in patients with active rheumatoid arthritis and inadequate response or intolerance to tumor necrosis factor inhibitors. Arthritis Rheumatol. 2017;69(2):277–290. Crossref, MedlineGoogle Scholar,
  • 19. A Study Comparing Upadacitinib (ABT-494) Monotherapy to Methotrexate (MTX) in Adults with Rheumatoid Arthritis (RA) Who Have Not Previously Taken Methotrexate (SELECT-EARLY). Available at https://www.clinicaltrials.gov/ct2/show/NCT02706873. Accessed April 03, 2021. Google Scholar,
  • 20. A Study Comparing Upadacitinib (ABT-494) Monotherapy to Methotrexate (MTX) in Adults with Rheumatoid Arthritis (RA) Who Have an Inadequate Response to MTX (SELECT-MONOTHERAPY). Available at https://clinicaltrials.gov/ct2/show/NCT02706951. Accessed April 03, 2021. Google Scholar,
  • 21. A Study Comparing Upadacitinib (ABT-494) to Placebo in Adults with Rheumatoid Arthritis on Stable dose of Conventional Synthetic Disease-Modifying Antirheumatic Drugs (csDMARDs) Who Have an Inadequate Response to csDMARDs Alone (SELECT-NEXT). Available at https://clinicaltrials.gov/ct2/show/NCT02675426. Accessed April 03, 2021. Google Scholar,
  • 22. A Study Comparing Upadacitinib (ABT-494) to Placebo and Adalimumab in Adults with Rheumatoid Arthritis Who Are in a Stable Dose of Methotrexate and Who Have an Inadequate Response to Methotrexate (SELECT-COMPARE). Available at https://clinicaltrials.gov/ct2/show/record/NCT02629159. Accessed April 03, 2021. Google Scholar,
  • 23. A Study Comparing Upadacitinib (ABT-494) to Placebo in Adults with Rheumatoid Arthritis on Stable dose of Conventional Synthetic Disease-Modifying Antirheumatic Drugs (csDMARDs) with an Inadequate Response to or Intolerance to Biologic DMARDs (SELECT-BEYOND). https://clinicaltrials.gov/ct2/show/NCT02706847. Accessed April 03, 2021. Google Scholar,

Patient Presentation

  • 1. Stanaszek WF, Carlstedt BC. Rheumatoid arthritis: Pathophysiology. J Pharm Pract. 1999;12(4):282–289. CrossrefGoogle Scholar,
  • 2. Smith HR, Brown A, Diamond HS. Rheumatoid arthritis. Accessed on 07/04/2018 from Updated June 6, 2018. https://emedicine.medscape.com/article/331715-overview. Accessed July 7, 2018. Google Scholar,
  • 3. Metsios GS, Stravropoulos-Kalinoglou A, Douglas KM, et al. Blockade of tumour necrosis factor-alpha in rheumatoid arthritis: Effects on components of rheumatoid cachexia. Rheumatology (Oxford). 2007;46(12):1824–1827. Crossref, MedlineGoogle Scholar,
  • 4. Wasserman AM. Diagnosis and management of rheumatoid arthritis. Am Fam Physician. 2011;84(11):1245–1252. MedlineGoogle Scholar,
  • 5. Aletaha D, Neogi T, Silman AJ, et al. 2010 rheumatoid arthritis classification criteria: An American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum. 2010;62(9):2569–2581. Crossref, MedlineGoogle Scholar,
  • 6. Singh JA, Furst DE, Bharat A, et al. 2012 update of the 2008 American College of Rheumatology recommendations for the use of disease-modifying antirheumatic drugs and biologic agents in the treatment of rheumatoid arthritis. Arthritis Care Res. 2012;64(5):625–639. CrossrefGoogle Scholar,

Treatment Goals

  • 1. Wasserman AM. Diagnosis and management of rheumatoid arthritis. Am Fam Physician. 2011;84(11):1245–1252. MedlineGoogle Scholar,

Disease State Management

Medications

Complementary and Integrative Health Approaches (CIHA)

  • 1. Zatura AJ, Davis MC, Reich JW, et al. Comparison of cognitive behavioral and mindfulness meditation interventions on adaptation to rheumatoid arthritis for patients with and without history of recurrent depression. J Consult Clin Psychol. 2008;76(3):408–421. Crossref, MedlineGoogle Scholar,
  • 2. Pradhan EK, Baumgarten M, Langenberg P, Handwerger B, Gilpin AK, Magyani T, et al. Effect of mindfulness-based stress reduction in rheumatoid arthritis patients. Arthritis Rheum. 2007;57(7):1134–1142. Crossref, MedlineGoogle Scholar,
  • 3. Dissanayake RK, Bertouch JV. Psychosocial interventions as adjunct therapy for patients with rheumatoid arthritis: A systematic review. Int J Rheum Dis. 2010;13(4):324–334. Crossref, MedlineGoogle Scholar,
  • 4. Lee MS, Pittler MH, Ernst E. Tai chi for rheumatoid arthritis: Systematic review. Rheumatology. 2007;46(11):1648–1651. Crossref, MedlineGoogle Scholar,
  • 5. Uhlig T, Fongen C, Steen E, Christie A, Ødegård S. Exploring Tai Chi in rheumatoid arthritis: A quantitative and qualitative study. BMC Musculoskelet Disord. 2010;11(1):43. Crossref, MedlineGoogle Scholar,
  • 6. Haaz S, Bartlett SJ. Yoga for arthritis: A scoping review. Rheum Dis Clin North Am. 2011;37(1):33–46. Crossref, MedlineGoogle Scholar,
  • 7. Bosch PR, Traustadóttir T, Howard P, Matt KS. Functional and physiological effects of yoga in women with rheumatoid arthritis: A pilot study. Altern Ther Health Med. 2009;15(4):24–31. MedlineGoogle Scholar,
  • 8. Efthimiou P, Kukar M. Complementary and alternative medicine use in rheumatoid arthritis: Proposed mechanism of action and efficacy of commonly used modalities. Rheumatol Int. 2010;30(5):571–586. Crossref, MedlineGoogle Scholar,
  • 9. Furst DE, Venkatraman MM, McGann M, et al. Double-blind, randomized, controlled, pilot study comparing classic Ayurvedic medicine, methotrexate, and their combination in rheumatoid arthritis. J Clin Rheumatol. 2011;17(4):185–192. Crossref, MedlineGoogle Scholar,

Monitoring and Follow-Up

  • 1. Methotrexate oral tablets [package insert]. Columbus, OH: Roxane Laboratories, Inc; 2008. Google Scholar,
  • 2. Plaquenil (hydroxychloroquine sulfate) oral tablets [package insert]. Kansas City, MO: Concordia Pharmaceuticals Inc; 2017. Google Scholar,
  • 3. Marmor MF, Kellner U, Lai TYY, Melles RB, Mieler WF; American Academy of Ophthalmology. Recommendations on screening for chloroquine and hydroxychloroquine retinopathy (2016 revision). Ophthalmology. 2016;123(6):1386–1394. Crossref, MedlineGoogle Scholar,
  • 4. Arava (leflunomide) oral tablets [package insert]. Bridgewater, NJ: Sanofi-Aventis; 2011. Google Scholar,
  • 5. Azulfidine (sulfasalazine) oral tablets [package insert]. New York, NY: Pharmacia & Upjohn Co; 2014. Google Scholar,
  • 6. Singh JA, Saag KG, Bridges SL Jr, et al. 2015 American College of Rheumatology Guideline for the treatment of rheumatoid arthritis. Arthritis Care Res. 2015;68(1):1–25. CrossrefGoogle Scholar,
  • 7. Smolen JS, Landewé R, Bijlsma J, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann Rheum Dis. 2017;76(6):960–977. Crossref, MedlineGoogle Scholar,
  • 8. Actemra (tocilizumab) intravenous, subcutaneous injection [package insert]. South San Francisco, CA: Genentech; 2017. Google Scholar,
  • 9. Rituxan (rituximab) intravenous injection [package insert]. South San Francisco, CA: Genentech; 2018. Google Scholar,
  • 10. Orencia (abatacept) intravenous, subcutaneous injection [package insert]. Princeton, NJ: Bristol-Myers Squibb Company; 2017. Google Scholar,
  • 11. Xeljanz (tofacitinib) oral tablets [package insert]. New York, NY: Pfizer Labs; 2018. Google Scholar,
  • 12. Saag KG, Teng GG, Patkar NM, et al. American College of Rheumatology 2008 recommendations for the use of nonbiologic and biologic disease-modifying antirheumatic drugs in rheumatoid arthritis. Arthritis Rheum. 2008;59(6):762–784. Crossref, MedlineGoogle Scholar,
  • 13. Kevzara (sarilumab) injection, solution for subcutaneous use. Bridgewater, NJ: Sanofi-Aventis; 2017. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/761037s000lbl.pdf. Accessed on January 4, 2019. Google Scholar,
  • 14. Kojima M, Kojima T, Suzuki S, et al. Depression, inflammation, and pain in patients with rheumatoid arthritis. Arthritis Care Res. 2009;61(8):1018–1024. CrossrefGoogle Scholar,
  • 15. DiMatteo M, Lepper HS, Croghan TW. Depression is a risk factor for noncompliance with medical treatment: Meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med. 2000;160(14):2101–2107. Crossref, MedlineGoogle Scholar,
  • 16. Yilmaz V, Umay E, Gündoğdu I, Karaahmet ZÖ, Öztürk AE. Rheumatoid arthritis: Are psychological factors effective in disease flare? Eur J Rheumatol. 2017;4(2):127–132. Crossref, MedlineGoogle Scholar,
  • 17. Mollard E, Pedro S, Chakravarty E, Clowse M, Schumacher R, Michaud K. The impact of menopause on functional status in women with rheumatoid arthritis. Rheumatology. 2018;57(5):798–802. Crossref, MedlineGoogle Scholar,
  • 18. Schuman E, Bartlett SJ, Schieir O, et al. Overweight, obesity, and the likelihood of achieving sustained remission in early rheumatoid arthritis: Results from a multicenter prospective cohort study. Arthritis Care Res. 2018;70(8):1185–1191. CrossrefGoogle Scholar,
  • 19. Xeljanz® (tofacitinib) oral tablets [package insert]. New York, NY: Pfizer Labs; 2018. https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/203214s018lbl.pdf. Accessed on April 05, 2021. Google Scholar,
  • 20. Olumiant (baricitinib) oral tablets [package insert]. Indianapolis, IN.: Lilly USA, LLC; 2018. https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/207924s000lbl.pdf. Accessed on April 5, 2021. Google Scholar,
  • 21. RinvoqTM (upadacitinib) extended-release oral tablets [package insert]. 2019. https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/211675s000lbl.pdf. Revised 8/2019. Accessed on April 05, 2021. Google Scholar,

Practical Clinical Management Tips

  • 1. Singh JA, Saag KG, Bridges SL Jr, et al. 2015 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Care Res. 2015;68(1):1–25. CrossrefGoogle Scholar,

Impact on Special Populations

  • 1. Barbour KE, Helmick CG, Boring M, Brady TJ. Vital signs: Prevalence of doctor diagnosed arthritis and arthritis-attributable activity limitation—United States, 2013–2015. MMWR. March 10, 2017;66(9):246–253. MedlineGoogle Scholar,
  • 2. Vilen L, Baldassari AR, Callahan LF. Socioeconomic burden of pain in rheumatic disease. Clin Exp Rheumatol. 2017;35(5 suppl 107):S26-S31. MedlineGoogle Scholar,
  • 3. Withers M, Moran R, Nicassio P, Weisman MH, Karpouzas GA. Perspective of vulnerable US Hispanics with rheumatoid arthritis on depression: Awareness, barriers to disclosure, and treatment options. Arthritis Care Res. 2015;67(4):498–492. CrossrefGoogle Scholar,
  • 4. American College of Rheumatology. Position statement. https://www.rheumatology.org/Portals/0/Files/Access%20to%20Care.pdf. Accessed October 30, 2018. Google Scholar,
  • 5. Marengo MF, Suarez-Almazor ME. Improving treatment adherence in patients with rheumatoid arthritis: What are the options? Int J Clin Rheumtol. 2015;10(5):345–356. Crossref, MedlineGoogle Scholar,

Special Populations

  • 1. Del Rincón I, Battafarano DF, Arroyo RA, Murphy FT, Fischbach M, Escalante A. Ethnic variation in the clinical manifestations of rheumatoid arthritis: Role of HLA-DRB1 alleles. Arthritis Rheum. 2003;49(2):200–208. Crossref, MedlineGoogle Scholar,
  • 2. Bruce B, Fries JF, Murtagh KN. Health status disparities in ethnic minority patients with rheumatoid arthritis: A cross-sectional study. J Rheumatol. 2007;34(7):1475–1479. MedlineGoogle Scholar,
  • 3. Ringold S, Weiss PF, Beukelman T, et al. 2013 update of the 2011 American College of Rheumatology recommendations for the treatment of juvenile idiopathic arthritis: Recommendations for the medical therapy of children with systemic juvenile idiopathic arthritis and tuberculosis screening among children receiving biological medications. Arthritis Rheum. 2013;65(10):2499–2512. Crossref, MedlineGoogle Scholar,
  • 4. Skorpen CG, Hoeltzenbein M, Tincani A, et al. The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. Ann Rheum Dis. 2016;75(5):795–810. Crossref, MedlineGoogle Scholar,
  • 5. Krause ML, Makol A. Management of rheumatoid arthritis during pregnancy: Challenges and solutions. Open Access Rheumatol. 2016;8:23–36. MedlineGoogle Scholar,
  • 6. 2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases. Arthritis Care Res. 2021;72(4):461–488. https://doi.org/10.1002/acr.24130. Google Scholar,
  • 7. Kobak S, Bes C. An autumn tale: Geriatric rheumatoid arthritis. Ther Adv Musculoskelet Dis. 2018;10(1):3–11. Crossref, MedlineGoogle Scholar,

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