Med. praxi. 2022;19(1):10-17 | DOI: 10.36290/med.2022.001

Early diagnosis and therapy of rheumatoid arthritis

MUDr. Liliana Šedová, MUDr. Jana Tomasová Studýnková, Ph.D.

Revmatologický ústav, Praha

Rheumatoid arthritis is a chronic inflammatory autoimmune disease that, if untreated soon and adequately enough, leads to irreversible joint destruction, lifelong disability and development of associated comorbidities. The modern approach to this disease includes the early diagnosis, early start of effective therapy within 3 months of symptoms onset and "treat to target" strategy. The aim of this approach is the induction and maintenance of clinical remission, or at least low disease activity and prevention of structural damage. This principle requires "tight control"clinical assessment using composite disease activity index and treatment adjustment if the goal has not been reached, or maintained. The gold standard is the induction therapy with disease modifying anti-rheumatic drugs (preferentially methotrexate) in monotherapy or in combination with glucocorticoid in very active disease. In case of inadequate treatment response, the combination with biologic therapy is recommended. Nonsteroidal anti rheumatic drugs are used here in full anti-inflammatory dose as an adjuvant treatment. This article includes notes on special situations during the patient´s life (perioperative period, infection and vaccination against Covid19).

Keywords: rheumatoid arthritis, early diagnosis, therapy, disease activity, treat to target, perioperative period, vaccination.

Published: February 23, 2022  Show citation