Rheumatoid arthritis is a systemic autoimmune rheumatic disorder of unknown etiology.
It is the most common form of inflammatory arthritis.
Patient usually complains of joint pain and/or swelling with morning stiffness that lasts for more than an hour.

Goals of treatment are clinical & radiological remission of disease and to reduce functional limitations & permanent joint damage.

Follow Up

Monitoring for Drug Toxicity

  • Eg complete blood count, serum creatinine, liver function tests, hepatitis B & C screening, ophthalmologic exam, latent tuberculosis screening (for biological DMARDs, with chest X-ray)
  • Recommended prior to resuming or increasing therapy with DMARDs
  • It is important to monitor for toxicity due to the potential risks of serious adverse effects of DMARDs

Tapering of Therapy

  • Should be considered if there is disease remission with biological DMARDs therapy of at least 6 months
    • Glucocorticoid dose should be tapered first prior to reduction of dose of biological DMARDs
  • To decrease risk of flares, gradual withdrawal of biological therapies should be done
    • Flare risk is inversely proportional to disease activity & sustained response duration
  • In persistent remission of at least 12 months, biological DMARDs should be slowly tapered by expanding the interval between doses or dose reduction, while continuing non-biological DMARDs
  • Ceasing treatment with non-biological DMARDs is associated with increased flare frequency, hence tapering should be done cautiously & should be evaluated rigorously

Disease Activity Monitoring

  • Disease activity should be measured & documented regularly
    • Moderate-high disease activity: monthly
    • Sustained low disease activity: every 6 months
    • Clinical remission: every 6 months (with DAS & DAS28)
    • Sustained remission: every 3-6 months
  • Consider structural changes, comorbidities, & functional impairment when formulating treatment decisions on follow-ups
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