Pub Date : 2020-09-01DOI: 10.1093/med/9780198831433.003.0037
B. Coumbe, E. Nikiphorou, T. Sokka-Isler
The therapeutic armamentarium available for treatment of rheumatoid arthritis (RA) has changed significantly over the past 30 years, transforming the therapeutic landscape and prognosis for a substantial proportion of patients with RA. Combination therapies represent an important therapeutic paradigm for management of rheumatoid arthritis. The rationale for combination therapies is clear and demonstrated to bring treatment benefit to patients achieving lower disease activity scores and reduced radiologic progression according to ‘treat-to-target’ principles. A rigorous evidence-based debate is required involving not only parameters related to disease activity scores and radiologic progression, but related to the cost-effectiveness analysis of using many of these newer agents compared to older csDMARDs. This chapter addresses the evidence related to the utilization of combination strategies for the management of RA as compared to monotherapy.
{"title":"Combination therapy in rheumatoid arthritis","authors":"B. Coumbe, E. Nikiphorou, T. Sokka-Isler","doi":"10.1093/med/9780198831433.003.0037","DOIUrl":"https://doi.org/10.1093/med/9780198831433.003.0037","url":null,"abstract":"The therapeutic armamentarium available for treatment of rheumatoid arthritis (RA) has changed significantly over the past 30 years, transforming the therapeutic landscape and prognosis for a substantial proportion of patients with RA. Combination therapies represent an important therapeutic paradigm for management of rheumatoid arthritis. The rationale for combination therapies is clear and demonstrated to bring treatment benefit to patients achieving lower disease activity scores and reduced radiologic progression according to ‘treat-to-target’ principles. A rigorous evidence-based debate is required involving not only parameters related to disease activity scores and radiologic progression, but related to the cost-effectiveness analysis of using many of these newer agents compared to older csDMARDs. This chapter addresses the evidence related to the utilization of combination strategies for the management of RA as compared to monotherapy.","PeriodicalId":135409,"journal":{"name":"Oxford Textbook of Rheumatoid Arthritis","volume":"54 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115387431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-09-01DOI: 10.1093/med/9780198831433.003.0044
A. Zink, A. Strangfeld
Over the last 15 years, the European biologics registers have greatly increased our knowledge of the safety and effectiveness of biologic therapies in daily practice. They have convincingly shown that tumour necrosis factor (TNF) inhibitors do not increase the overall risk of solid or lymphoproliferative tumours. However, a slight increase in the risk of skin cancer cannot be ruled out. A higher risk of serious infections compared to csDMARDs has been identified which has to be taken into account in clinical care. The registers have identified the great impact of uncontrolled high disease activity on the risks of myocardial infarction, stroke, and overall mortality which underlines the importance of tight disease control. By their clinical effectiveness, the biologic agents therefore have the potential to prevent adverse outcomes. Overall, a favourable benefit-risk profile of TNFi and other biological agents has been observed, with some specific precautions in defined patient groups.
{"title":"European biologics registers","authors":"A. Zink, A. Strangfeld","doi":"10.1093/med/9780198831433.003.0044","DOIUrl":"https://doi.org/10.1093/med/9780198831433.003.0044","url":null,"abstract":"Over the last 15 years, the European biologics registers have greatly increased our knowledge of the safety and effectiveness of biologic therapies in daily practice. They have convincingly shown that tumour necrosis factor (TNF) inhibitors do not increase the overall risk of solid or lymphoproliferative tumours. However, a slight increase in the risk of skin cancer cannot be ruled out. A higher risk of serious infections compared to csDMARDs has been identified which has to be taken into account in clinical care. The registers have identified the great impact of uncontrolled high disease activity on the risks of myocardial infarction, stroke, and overall mortality which underlines the importance of tight disease control. By their clinical effectiveness, the biologic agents therefore have the potential to prevent adverse outcomes. Overall, a favourable benefit-risk profile of TNFi and other biological agents has been observed, with some specific precautions in defined patient groups.","PeriodicalId":135409,"journal":{"name":"Oxford Textbook of Rheumatoid Arthritis","volume":"152 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132087963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-09-01DOI: 10.1093/med/9780198831433.003.0043
A. Aga, E. Haavardsholm, T. Uhlig, T. Kvien
This chapter will review the most important recommendations that are relevant for evidence-based clinical practice. The main focus will be on recommendations that are specific to rheumatoid arthritis (RA) but some recommendation on special topics (e.g. biosimilars) will also be addressed. The literature to support evidence-based medicine is enormous, but the scientific quality may differ across studies. Recommendations based on systematic literature research may support evidence-based practice. Both the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR) have published several important evidence-based recommendations. Further, task forces independent of these organizations have also presented important recommendations to support best practice. New treatment strategies have also improved RA care to an extent where remission has become an achievable goal for the majority of patients with RA. Important principles in the new treatment strategies are ‘window of opportunity’ which imply early initiation of disease-modifying antirheumatic drugs (DMARDs) before the onset of damage, and further ‘treat-to-target’ which is a strategy for follow-up with focus on reaching a predefined target, and where DMARD treatment is adjusted if the target is not achieved. Patients with early disease are monitored with ‘tight controls’, and with use of composite disease activity measures that includes joint counts.
{"title":"Clinical recommendations","authors":"A. Aga, E. Haavardsholm, T. Uhlig, T. Kvien","doi":"10.1093/med/9780198831433.003.0043","DOIUrl":"https://doi.org/10.1093/med/9780198831433.003.0043","url":null,"abstract":"This chapter will review the most important recommendations that are relevant for evidence-based clinical practice. The main focus will be on recommendations that are specific to rheumatoid arthritis (RA) but some recommendation on special topics (e.g. biosimilars) will also be addressed. The literature to support evidence-based medicine is enormous, but the scientific quality may differ across studies. Recommendations based on systematic literature research may support evidence-based practice. Both the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR) have published several important evidence-based recommendations. Further, task forces independent of these organizations have also presented important recommendations to support best practice. New treatment strategies have also improved RA care to an extent where remission has become an achievable goal for the majority of patients with RA. Important principles in the new treatment strategies are ‘window of opportunity’ which imply early initiation of disease-modifying antirheumatic drugs (DMARDs) before the onset of damage, and further ‘treat-to-target’ which is a strategy for follow-up with focus on reaching a predefined target, and where DMARD treatment is adjusted if the target is not achieved. Patients with early disease are monitored with ‘tight controls’, and with use of composite disease activity measures that includes joint counts.","PeriodicalId":135409,"journal":{"name":"Oxford Textbook of Rheumatoid Arthritis","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129631938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-09-01DOI: 10.1093/med/9780198831433.003.0021
E. Dures, N. Basu
Fatigue in rheumatoid arthritis (RA) is associated with inflammation, pain, disability, sleep, depression, and health beliefs, implying complex, multicausal pathways comprising differing combinations of variables. From a patient perspective, it is a common, overwhelming, and distressing symptom. From a societal perspective, fatigue is a significant predictor of high healthcare costs and the main reason for work disability and loss. This chapter will highlight the role of patients in establishing the importance of the symptom, including the proposal that it should be measured in studies of RA whenever possible. Acknowledgement of fatigue as a patient priority is a relatively recent development, and highlights the value of collaborating with patients in shaping the research agenda. There will be discussion of the scale of fatigue in RA, including data on prevalence and descriptions of its nature and impact. Research has established the unpredictable and unearned nature of RA-related fatigue with its physical, cognitive, and emotional components, and identified the associated individual and societal burden. This will be followed by conceptual models informing our understanding of the biology of rheumatoid arthritis-related fatigue, the role of bioinformatics, and the challenges of unravelling the mechanisms of this multidimensional symptom. Finally, the evidence for interventions and treatments to alleviate fatigue will be presented, with a focus on non-pharmacological approaches to support fatigue self-management.
{"title":"Fatigue","authors":"E. Dures, N. Basu","doi":"10.1093/med/9780198831433.003.0021","DOIUrl":"https://doi.org/10.1093/med/9780198831433.003.0021","url":null,"abstract":"Fatigue in rheumatoid arthritis (RA) is associated with inflammation, pain, disability, sleep, depression, and health beliefs, implying complex, multicausal pathways comprising differing combinations of variables. From a patient perspective, it is a common, overwhelming, and distressing symptom. From a societal perspective, fatigue is a significant predictor of high healthcare costs and the main reason for work disability and loss. This chapter will highlight the role of patients in establishing the importance of the symptom, including the proposal that it should be measured in studies of RA whenever possible. Acknowledgement of fatigue as a patient priority is a relatively recent development, and highlights the value of collaborating with patients in shaping the research agenda. There will be discussion of the scale of fatigue in RA, including data on prevalence and descriptions of its nature and impact. Research has established the unpredictable and unearned nature of RA-related fatigue with its physical, cognitive, and emotional components, and identified the associated individual and societal burden. This will be followed by conceptual models informing our understanding of the biology of rheumatoid arthritis-related fatigue, the role of bioinformatics, and the challenges of unravelling the mechanisms of this multidimensional symptom. Finally, the evidence for interventions and treatments to alleviate fatigue will be presented, with a focus on non-pharmacological approaches to support fatigue self-management.","PeriodicalId":135409,"journal":{"name":"Oxford Textbook of Rheumatoid Arthritis","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131719374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-09-01DOI: 10.1093/med/9780198831433.003.0005
A. Barton
Rheumatoid arthritis (RA) is known to have a genetic component: the evidence comes from twin and family studies as well as genetic studies themselves. Family studies consistently confirm that first degree relatives of patients with RA are at increased risk of developing the condition, supporting a genetic component. The most robust data comes from the Icelandic genealogical database. This chapter covers the basics of genetic studies in RA, designing the genetic study, RA-specific results and insights that can be gained from these. Detailed analyses of selected genetic regions are discussed, alongside genes that may indicate severity. Genetic factors associated with treatment response are also considered. Finally, the role of epigenetics is covered.
{"title":"Genetics and epigenetics of rheumatoid arthritis","authors":"A. Barton","doi":"10.1093/med/9780198831433.003.0005","DOIUrl":"https://doi.org/10.1093/med/9780198831433.003.0005","url":null,"abstract":"Rheumatoid arthritis (RA) is known to have a genetic component: the evidence comes from twin and family studies as well as genetic studies themselves. Family studies consistently confirm that first degree relatives of patients with RA are at increased risk of developing the condition, supporting a genetic component. The most robust data comes from the Icelandic genealogical database. This chapter covers the basics of genetic studies in RA, designing the genetic study, RA-specific results and insights that can be gained from these. Detailed analyses of selected genetic regions are discussed, alongside genes that may indicate severity. Genetic factors associated with treatment response are also considered. Finally, the role of epigenetics is covered.","PeriodicalId":135409,"journal":{"name":"Oxford Textbook of Rheumatoid Arthritis","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134393084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-09-01DOI: 10.1093/med/9780198831433.003.0024
L. Bearne, C. Opava
This chapter provides an overview of the role of physical activity and exercise in the management of people with rheumatoid arthritis (RA). It defines the concepts of physical activity, exercise, and sedentary behaviour and considers how these are measured objectively and subjectively in research studies and clinical practice. The symptoms and disabilities targeted by appropriately prescribed interventions are discussed and the growing evidence base for the effects of exercise in people with RA is highlighted. The recommendations and guidelines for health-enhancing physical activity and exercise prescription are reviewed and the factors that influence adherence to these are acknowledged. Suggestions of how clinicians may adapt their management approach to facilitate the uptake and maintenance of health-enhancing physical activity and exercise are considered.
{"title":"Physical activity and exercise","authors":"L. Bearne, C. Opava","doi":"10.1093/med/9780198831433.003.0024","DOIUrl":"https://doi.org/10.1093/med/9780198831433.003.0024","url":null,"abstract":"This chapter provides an overview of the role of physical activity and exercise in the management of people with rheumatoid arthritis (RA). It defines the concepts of physical activity, exercise, and sedentary behaviour and considers how these are measured objectively and subjectively in research studies and clinical practice. The symptoms and disabilities targeted by appropriately prescribed interventions are discussed and the growing evidence base for the effects of exercise in people with RA is highlighted. The recommendations and guidelines for health-enhancing physical activity and exercise prescription are reviewed and the factors that influence adherence to these are acknowledged. Suggestions of how clinicians may adapt their management approach to facilitate the uptake and maintenance of health-enhancing physical activity and exercise are considered.","PeriodicalId":135409,"journal":{"name":"Oxford Textbook of Rheumatoid Arthritis","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125437720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-09-01DOI: 10.1002/9781118532331.ch38
V. Strand, J. Kaine, J. Isaacs
Biologic therapy for treatment of rheumatoid arthritis (RA) has evolved considerably over the past 20 years. Biosimilar development continues to accelerate at a frenetic pace worldwide. Initial regulatory efforts were developed within the EU and subsequent guidelines have now evolved in over 20 countries. Biosimilars by definition are highly similar, with ‘comparable quality, safety, and efficacy’ (EMA) and ‘no clinically meaningful differences in safety, purity, and potency’ (FDA) to the reference product. Development and manufacturing are based on reverse engineering of the reference product as only the primary amino acid sequence is known. Testing of primary, secondary, tertiary, and quaternary structure, binding pharmacokinetics, and stability is required. Characterization of post-translational modifications and biologic function, pharmacokinetics, evaluation of immunogenicity, and at least one comparative efficacy clinical trial are major requirements for regulatory approval. Clinical trials to assess biosimilarity are required in only one clinical indication and may be extrapolated to other indications for which the reference product is approved. Both single and multiple switching trials (between biosimilar and reference product) have yielded consistent results across numerous patient populations and diseases, with no evidence of detrimental outcomes. Two prospective large observational series (Danbio and Nor-Switch) have similarly assessed non-medical switching. Several open-label switching studies have revealed equivalent efficacy, safety, and discontinuation rates but real-world studies have raised concerns about potential nocebo responses.
{"title":"Biosimilars","authors":"V. Strand, J. Kaine, J. Isaacs","doi":"10.1002/9781118532331.ch38","DOIUrl":"https://doi.org/10.1002/9781118532331.ch38","url":null,"abstract":"Biologic therapy for treatment of rheumatoid arthritis (RA) has evolved considerably over the past 20 years. Biosimilar development continues to accelerate at a frenetic pace worldwide. Initial regulatory efforts were developed within the EU and subsequent guidelines have now evolved in over 20 countries. Biosimilars by definition are highly similar, with ‘comparable quality, safety, and efficacy’ (EMA) and ‘no clinically meaningful differences in safety, purity, and potency’ (FDA) to the reference product. Development and manufacturing are based on reverse engineering of the reference product as only the primary amino acid sequence is known. Testing of primary, secondary, tertiary, and quaternary structure, binding pharmacokinetics, and stability is required. Characterization of post-translational modifications and biologic function, pharmacokinetics, evaluation of immunogenicity, and at least one comparative efficacy clinical trial are major requirements for regulatory approval. Clinical trials to assess biosimilarity are required in only one clinical indication and may be extrapolated to other indications for which the reference product is approved. Both single and multiple switching trials (between biosimilar and reference product) have yielded consistent results across numerous patient populations and diseases, with no evidence of detrimental outcomes. Two prospective large observational series (Danbio and Nor-Switch) have similarly assessed non-medical switching. Several open-label switching studies have revealed equivalent efficacy, safety, and discontinuation rates but real-world studies have raised concerns about potential nocebo responses.","PeriodicalId":135409,"journal":{"name":"Oxford Textbook of Rheumatoid Arthritis","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133802631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-09-01DOI: 10.1093/med/9780198831433.003.0026
A. Hammond, Joanne Adams, Yeliz Prior
People with rheumatoid arthritis can find it painful, tiring, and frustrating to perform their daily activities, work, family and social responsibilities, and leisure. While drug therapy has improved outcomes, many still experience limitations in their daily lives. Occupational therapy aims to: improve clients’ abilities to perform their activities and participate in their social roles; reduce pain and fatigue; improve or maintain physical function; improve or maintain psychological status; help people self-manage their condition successfully and adapt to changes in their lifestyle; achieve a healthy work and personal life balance. People with participation restrictions have poorer psychological and physical outcomes. Helping people participate in their roles, as and when they wish to, is an important part of rehabilitation to maximize clients’ quality of life. Occupational therapists use a wide range of educational, physical, social, psychological, and work-related interventions to help people live their lives as successfully as possible.
{"title":"Occupational therapy","authors":"A. Hammond, Joanne Adams, Yeliz Prior","doi":"10.1093/med/9780198831433.003.0026","DOIUrl":"https://doi.org/10.1093/med/9780198831433.003.0026","url":null,"abstract":"People with rheumatoid arthritis can find it painful, tiring, and frustrating to perform their daily activities, work, family and social responsibilities, and leisure. While drug therapy has improved outcomes, many still experience limitations in their daily lives. Occupational therapy aims to: improve clients’ abilities to perform their activities and participate in their social roles; reduce pain and fatigue; improve or maintain physical function; improve or maintain psychological status; help people self-manage their condition successfully and adapt to changes in their lifestyle; achieve a healthy work and personal life balance. People with participation restrictions have poorer psychological and physical outcomes. Helping people participate in their roles, as and when they wish to, is an important part of rehabilitation to maximize clients’ quality of life. Occupational therapists use a wide range of educational, physical, social, psychological, and work-related interventions to help people live their lives as successfully as possible.","PeriodicalId":135409,"journal":{"name":"Oxford Textbook of Rheumatoid Arthritis","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132746188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-09-01DOI: 10.1093/med/9780198831433.003.0025
H. Siddle, A. Redmond
This chapter discusses and emphasizes the effects that a complex multisystem disease such as rheumatoid arthritis (RA) has on a weight-bearing structure. The foot is frequently described by people with RA as ‘the first to be affected but the last to be treated’. An overview of subjective and objective assessment tools, including clinical and imaging modalities is reviewed. This chapter encourages the clinician to ask the important question, ‘Have you had any problems with your feet recently?’ and provides a simple assessment approach and knowledge of further assessment strategies to ensure that the foot is adequately assessed to avoid long-term complications. The relevant non-surgical foot health management strategies have been highlighted for people with RA who frequently present with both inflammatory and mechanical disease in their feet, with the aim of minimizing the impact on the foot and ankle.
{"title":"Foot health","authors":"H. Siddle, A. Redmond","doi":"10.1093/med/9780198831433.003.0025","DOIUrl":"https://doi.org/10.1093/med/9780198831433.003.0025","url":null,"abstract":"This chapter discusses and emphasizes the effects that a complex multisystem disease such as rheumatoid arthritis (RA) has on a weight-bearing structure. The foot is frequently described by people with RA as ‘the first to be affected but the last to be treated’. An overview of subjective and objective assessment tools, including clinical and imaging modalities is reviewed. This chapter encourages the clinician to ask the important question, ‘Have you had any problems with your feet recently?’ and provides a simple assessment approach and knowledge of further assessment strategies to ensure that the foot is adequately assessed to avoid long-term complications. The relevant non-surgical foot health management strategies have been highlighted for people with RA who frequently present with both inflammatory and mechanical disease in their feet, with the aim of minimizing the impact on the foot and ankle. ","PeriodicalId":135409,"journal":{"name":"Oxford Textbook of Rheumatoid Arthritis","volume":"85 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122085225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-09-01DOI: 10.1093/med/9780198831433.003.0018
A. Filer, M. D’Agostino, I. Sahbudin
Ultrasound in increasingly used in rheumatology practice in the assessment of inflammatory patient, including facilitating early diagnosis of rheumatoid arthritis (RA), predicting its outcome, measuring structural damage, and monitoring its progression. This imaging modality can visualize both inflammatory and structural changes in patients with unclassified arthritis and RA, as well as other inflammatory arthritides such as psoriatic arthritis (PsA), spondyloarthropathy (SpA), and crystal arthritis. This chapter aims to provide an overview of the recent advances of this technique for in the assessment of RA. Firstly, the principles which underpin the physics of ultrasound are summarized, followed by the musculoskeletal pathologies which are amenable to ultrasound examination. In addition, it also highlights the role of ultrasound in procedures (e.g. ultrasound-guided biopsy and ultrasound-guided injection).
{"title":"Ultrasound in rheumatoid arthritis","authors":"A. Filer, M. D’Agostino, I. Sahbudin","doi":"10.1093/med/9780198831433.003.0018","DOIUrl":"https://doi.org/10.1093/med/9780198831433.003.0018","url":null,"abstract":"Ultrasound in increasingly used in rheumatology practice in the assessment of inflammatory patient, including facilitating early diagnosis of rheumatoid arthritis (RA), predicting its outcome, measuring structural damage, and monitoring its progression. This imaging modality can visualize both inflammatory and structural changes in patients with unclassified arthritis and RA, as well as other inflammatory arthritides such as psoriatic arthritis (PsA), spondyloarthropathy (SpA), and crystal arthritis. This chapter aims to provide an overview of the recent advances of this technique for in the assessment of RA. Firstly, the principles which underpin the physics of ultrasound are summarized, followed by the musculoskeletal pathologies which are amenable to ultrasound examination. In addition, it also highlights the role of ultrasound in procedures (e.g. ultrasound-guided biopsy and ultrasound-guided injection).","PeriodicalId":135409,"journal":{"name":"Oxford Textbook of Rheumatoid Arthritis","volume":"75 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115149172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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