Headnote
Disease-modifying drugs reduce pain, but extra analgesia is usually needed, explains Professor Bruce Kidd
Rheumatoid arthritis (RA) is an inflammatory disease of unknown cause, mainly affecting synovial joints. Typically, the small joints of the hands and feet are involved in a symmetrical pattern, although any joint may be affected.
Patients experience pain and symptoms such as fatigue and malaise. Less commonly, there may be involvement of other organ systems, including the eyes, skin, lungs and vasculature. RA is now considered to be a risk factor for IHD, leading to shortened life expectancy in many patients.
It is accepted that early treatment of RA is associated with better outcomes, although diagnosis of early synovitis remains a problem. Widely-used classification criteria do not facilitate the diagnosis of early disease, but may be more useful in identifying patients with a poorer prognosis.
Standard inflammatory markers may not necessarily be abnormal in early disease, although MRI and, more particularly, high-definition ultrasound are emerging as sensitive methods fordemonstratingsynovitis.