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Supplements Improving Clinical and Managed Care Outcomes in Rheumatoid Arthritis: New Guidelines, Therapies, and

Epidemiology, Pathophysiology, and Diagnosis of Rheumatoid Arthritis: A Synopsis

Allan Gibofsky, MD, JD, FACP, FCLM
According to the 2010 ACR/EULAR classification criteria, values for RF and ACPA, markers of autoimmune dysfunction, are scored according to ranges of values, where normal is defined as less than the upper limit of normal (ULN) for the laboratory or assay, lowpositive is between the ULN and less than 3 times the ULN, and high-positive is greater than 3 times the ULN. ESR and CRP levels are scored based on whether they are normal or abnormal according to reference laboratory standards. The 2010 classification criteria factor duration of therapy, but not the presence or absence of radiographic changes, into the final score. The authors of the 2010 ACR/EULAR classification criteria recommend that the guidelines be used for assessment of existing and future patients to facilitate earlier use of therapies capable of altering disease progression.55


RA, a common autoimmune disease, is associated with inflammation and swelling of the synovium of the joint and, if left untreated, often results in destruction of both the bony and cartilaginous elements of the joint and resultant disability. A variety of comorbidities associated with systemic inflammation contribute to the increased mortality seen in patients with RA compared with the general population. Although the pathophysiology of RA is not completely understood, the process generally involves dysregulated inflammation, with antigen presentation, T-cell activation, and autoantibody production all serving as mediators in the inflammatory process. Diagnosis of RA is based on the patient history and physical examination demonstrating synovitis in multiple joints. Indices of disease activity have been developed to guide treat-to-target approaches to pharmacological intervention.

Author affiliations: Weill Medical College of Cornell University, New York, NY, and Hospital for Special Surgery, New York, NY.
Funding source: This activity is supported by an educational grant from Antares Pharma, Inc.
Author disclosure: Dr Gibofsky reports serving as a consultant for AbbVie, Amgen, Antares Pharma, Inc, Celgene, Iroko, and Pfizer. Dr Gibofsky also reports serving on a speaker’s bureau for AbbVie, Amgen, Antares Pharma, Inc, Celgene, Iroko, Pfizer, and UCB. He reports stock ownership with AbbVie, Amgen, Bristol-Myers Squibb, GlaxoSmithKline, Johnson & Johnson, Pfizer, and Regeneron.
Authorship information: Concept and design; acquisition of data; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content; and supervision.
Address correspondence to: Allan Gibofsky, MD, JD, FACP, FCLM, 535 E 70th St, New York, NY 10021. E-mail:
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