Rheumatoid arthritis

The aim is to induce early clinical remission with prompt diagnosis and timely introduction of disease-modifying antirheumatic drugs (DMARDs). Diagnosis is primarily based on history and examination of the joints. Inflammatory laboratory markers (CRP and ESR) may be normal. The presence of anti-cyclic citrullinated peptide (anti-CCP) antibodies is more specific for rheumatoid arthritis (RA) than the presence of rheumatoid factor. If RA is strongly suspected (polyarthritis) the patient must be referred to specialist care without delay. The combination of several drugs is more effective than monotherapy. Over half of patients with early RA are rendered asymptomatic with combination therapy (methotrexate + sulfasalazine + hydroxychloroquine + low-dose prednisolone) . If sufficient response is not achieved with the above-mentioned therapy, treatment with biological agents (biological response modifiers, biologics) is started. Glucocorticoids should not be started in primary care since they may delay diagnosis and hamper the assessment of disease severity.

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Medicine