Management of extra-articular disease manifestations in RA

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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, Rochester,

Minnesota, USA, and the Department of Rheumatology, Malmo University

Hospital, Malmo, Sweden.

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

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Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org