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Supplements Improving Clinical and Managed Care Outcomes in Rheumatoid arthritis: a Focus on Comparative Effecti

Overview of Epidemiology, Pathophysiology, and Diagnosis of Rheumatoid Arthritis

Allan Gibofsky, MD, JD, FACP, FCLM
Established indices focus primarily on articular measures, but do not account specifically for extra-articular manifestations. The 2012 update of the 2008 ACR RA treatment recommendations provides guidance to determine disease activity (LDA, MDA, HDA, or remission) and features of poor prognosis.32,33 Poor prognosis is associated with any of the following features of disease: functional limitation on standardized health questionnaires, extra-articular disease, positive RF, positive ACPA, or bony erosions documented by radiograph.


RA, a systemic autoimmune disease involving the joints and other organs, is associated with pain, disability, and mortality. Recent focus on identification of the disease earlier in the process, before extensive joint and bone damage occurs, brings hope for further improvements in the management of RA. Antigen presentation, T-cell activation, autoantibody production, TNF-α, and IL-6 are central mediators in the pathophysiology of articular and extra-articular RA. Standard disease activity indices may be used to guide treatto- target approaches to pharmacologic intervention, which is the focus of the next article in this supplement.

Author affiliation: Weill Medical College of Cornell University, Hospital for Special Surgery, New York, NY.
Funding source: This activity is supported by an educational grant from Bristol-Myers Squibb.
Author disclosure: Dr Gibofsky reports consultancy/advisory board membership, honoraria, lectureship, and stock ownership with Abbott, Amgen, Genentech, Pfizer, and UCB. He also reports stock ownership with Johnson & Johnson and GlaxoSmithKline.
Authorship information: Analysis and interpretation of data; drafting of the manuscript; and critical revision of the manuscript for important intellectual content.
Address correspondence to: Mail to: Allan Gibofsky, MD, Hospital for Special Surgery, 535 E 70th St, New York, NY 10075. E-mail: gibofskya@
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