[Rheumatoid Arthritis].

Abstract

Rheumatoid arthritis (RA) is an inflammatory systemic disease that mainly, but not exclusively, affects the joints and other structures of the musculoskeletal system. It most typically manifests in polyarthritis due to a highly inflammatory autoimmune synovitis. Extra-articular manifestations might also show in the shape of an interstitial lung disease or vasculitis, mainly affecting the small vessels. Early, well-targeted treatment can have a major impact on the progression of the disease; without treatment, however, patients are most likely to experience an irreversible loss of functionality and increased mortality. The administration of a DMARD starting as soon as being diagnosed is recommended. The first choice in medication should be methotrexate whenever there are no contraindications. In most cases, glucocorticoids are added temporarily with administration coming to a complete stop after 3-6 months. Therapy follows the treat-to-target principle aiming at remission. Disease activity and remission are calculated in scores combining clinical findings, patients' statements and laboratory tests for inflammatory activity. Treatment is considered responsive with achieving a minimum of a 50% reduction of the score. Score responses are evaluated after 12 weeks, therapeutic targets after 24. If 1 of the 2 is not met and there are no risk factors present for a severe progression of the disease, then another strategy with conventional systemic (cs)DMARD will first be used after methotrexate; otherwise biological (b)DMARD or other targeted synthetic (ts)DMARD can be given. Re-evaluation is carried out as described above, and if the target is not met, other b- or ts-DMARDs will be used.