CLNICAL TRIALS WARSZAW
CLNICAL TRIALS WARSZAW
A chronic inflammatory disease that, in addition to the joints, can involve internal organs: lungs, heart, and kidneys. Rheumatoid arthritis (RA) is characterized by a chronic, generalized, progressive inflammatory process with an immunological basis. It most commonly presents as symmetrical inflammation of the joints of the hands and feet, but pain and swelling also occur in other joints, including the knees, ankles, elbows, and shoulders. In most patients, RA leads to joint destruction, deformities, and limited mobility.
Symptoms of the Disease
Most patients with RA report morning stiffness in the joints and periarticular area as one of the dominant symptoms. It usually takes at least an hour to “limber up” and reach maximum possible mobility. In long-standing disease, subcutaneous nodules appear over bony prominences, extensor tendons, or in periarticular areas. As a consequence of chronic, uncontrolled inflammation, other organs and systems may become involved (e.g., lungs, kidneys, heart, and blood vessels). These changes are referred to as extra-articular complications of rheumatoid arthritis.
In supplemental blood tests, a positive rheumatoid factor (RF) and/or the presence of anti-CCP antibodies are found. In a small percentage of people with RA, RF and anti-CCP antibodies are not detected. This form of RA is referred to as seronegative. Radiological changes (erosions) visible in the joints of the hands or feet indicate long-standing disease and confirm the previous diagnosis.
Treatment of Rheumatoid Arthritis
Starting intensive treatment as quickly as possible—ideally within 3 months of the onset of symptoms—is crucial, as the chance of achieving remission is then greatest. Furthermore, irreversible destructive changes in the joints can occur within the first months of the disease. It is therefore vital to prevent this as early as possible.
The first drug administered is usually Methotrexate (a DMARD). The choice of subsequent drugs (including Sulfasalazine, Leflunomide, Arechin) and the treatment regimen depends on the response to Methotrexate and the patient’s tolerance. During treatment, systematic rheumatological monitoring and assessment of disease activity are important. In cases of significant exacerbation and lack of response to standard treatment, the patient is qualified for biologic drugs (e.g., Infliximab, Adalimumab, Etanercept, Rituximab, Certolizumab Pegol).
Goals of RA treatment: