Management of extra-articular disease manifestations in rheumatoid arthritis

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1: Curr Opin Rheumatol. 2004 May;16(3):206-11.

Management of extra-articular disease manifestations in rheumatoid

arthritis.

Turesson C, Matteson EL.

Division of Rheumatology, Mayo Clinic College of Medicine, 200 First Street

SW, Rochester, MN 55905, USA. Carl.Turesson@...

PURPOSE OF REVIEW: To discuss the rationale for various treatment strategies

in rheumatoid arthritis with extra-articular manifestations, and to review

advances in understanding the impact of extra-articular rheumatoid arthritis

and its management. RECENT FINDINGS: Recent epidemiologic studies of

extra-articular rheumatoid arthritis manifestations have emphasized their

major role as predictors of premature mortality in patients with rheumatoid

arthritis, and provide a rationale for aggressive ant-rheumatic treatment of

extra-articular rheumatoid arthritis. Previous uncontrolled or nonrandomized

studies favor the use of cyclophosphamide in patients with systemic

rheumatoid vasculitis, and methotrexate in the case of other manifestations

of extra-articular rheumatoid arthritis. Recent case reports indicate that

patients with rheumatoid lung disease may respond to cyclosporine or tumor

necrosis factor inhibitors, and that tumor necrosis factor blocking therapy

also may be successful in cases of treatment-resistant vasculitis. By

contrast, it has been suggested that tumor necrosis factor inhibitors may

induce some manifestations of extra-articular rheumatoid arthritis. Data

indicating a high risk of serious infections and cardiovascular disease in

patients with extra-articular rheumatoid arthritis underline the importance

of carefully monitoring such patients. SUMMARY: Extra-articular rheumatoid

arthritis is a serious condition, and rheumatoid arthritis patients with

extra-articular manifestations should be aggressively treated and monitored.

Advances in the understanding of the pathogenesis of rheumatoid arthritis

and developments of new, more specific drugs may be of particular benefit to

patients with extra-articular disease.

PMID: 15103246 [PubMed]