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Reumatoid artrit, RA

Senast uppdaterad: Senast reviderad:
Sakkunnig:
Definition:
En kronisk, inflammatorisk sjukdom som framförallt drabbar leder i händer och fötter.
Förekomst:
Prevalensen uppskattas till cirka 0,7 % i Sverige.
Symtom:
Symmetriska ledinflammationer, särskilt i händer och fötter, men alla leder kan drabbas. Allmänsymtom är vanligt.
Kliniska fynd:
Vid nydebuterad RA ses ofta artriter i MCP-, PIP- och MTP-leder, men debut med mono- eller oligoartrit i andra leder förekommer.
Diagnostik:
Anti-CCP, RF, SR, CRP, blodstatus och röntgen.
Behandling:
Centralt i behandlingen är syntetiska DMARDs och biologiska DMARDs. Tidigt insatt behandling är viktigt.
  1. Wasserman AM. Diagnosis and management of rheumatoid arthritis. Am Fam Physician 2011; 84: 1245-52. PMID: 22150658 PubMed  
  2. Scott DL, Wolfe F, Huizinga TWJ. Rheumatoid arthritis. Seminar. Lancet 2010; 376: 1094-1108. PubMed  
  3. Neovius, M., Simard, J. F., Askling, J. Nationwide prevalence of rheumatoid arthritis and penetration of disease-modifying drugs in Sweden. Ann Rheum Dis, 2011;70, 624-9. pmid: 21149495. PubMed  
  4. Eriksson JK, Neovius M, Ernestam S, Lindblad S, Simard JF, Askling J. Incidence of rheumatoid arthritis in Sweden: a nationwide population-based assessment of incidence, its determinants, and treatment penetration. Arthritis Care Res (Hoboken). 2013 Jun;65(6):870-8. doi: 10.1002/acr.21900. PMID: 23281173 PubMed  
  5. Scherer HU, Häupl T, Burmester GR. The etiology of rheumatoid arthritis. J Autoimmun. 2020 Jun;110:102400. Epub 2020 Jan 22. PMID: 31980337 PubMed  
  6. Aletaha D, Smolen JS. Diagnosis and Management of Rheumatoid Arthritis: A Review. JAMA. 2018 Oct 2;320(13):1360-1372. PMID: 30285183 PubMed  
  7. Wasserman A. Rheumatoid Arthritis: Common Questions About Diagnosis and Management. Am Fam Physician. 2018 Apr 1;97(7):455-462. PMID: 29671563 PubMed  
  8. Mikuls TR, Payne JB, Reinhardt RA, et al. Antibody responses to Porphyromonas gingivalis (P. gingivalis) in subjects with rheumatoid arthritis and periodontitis. Int Immunopharmacol 2009; 9: 38-42. PMID: 18848647 PubMed  
  9. Rantapää-Dahlqvist, S., de Jong, B. A., Berglin, E., Hallmans, G., Wadell, G., Stenlund, H., et al. 2003. Antibodies against cyclic citrullinated peptide and IgA rheumatoid factor predict the development of rheumatoid arthritis. Arthritis Rheum, 48, 2741-9. PMID: 14558078 PubMed  
  10. Nationellt kliniskt kunskapsstöd. Reumatoid artrit. Hämtad 2022-01-09 nationelltklinisktkunskapsstod.se  
  11. Aletaha, D., Neogi, T., Silman, A. J., Funovits, J., Felson, D. T., Bingham, C. O., 3rd, et al. 2010. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis, 69, 1580-8. PMID: 20872595 PubMed  
  12. Nishimura, K., Sugiyama, D., Kogata, Y., Tsuji, G., Nakazawa, T., Kawano, S., et al. 2007. Meta-analysis: diagnostic accuracy of anti-cyclic citrullinated peptide antibody and rheumatoid factor for rheumatoid arthritis. Ann Intern Med, 146, 797-808. PMID: 17548411 PubMed  
  13. Payet J, Goulvestre C, Biale L, et al. Anticyclic Citrullinated Peptide Antibodies in Rheumatoid and Nonrheumatoid Rheumatic Disorders: Experience with 1162 Patients. J Rheumatol. 2014 Oct 1. pii: jrheum.131375. PMID: 25274898. PubMed  
  14. Ford JA, Marshall AA, Liu X, et al. Impact of Cyclic Citrullinated Peptide Antibody Level on Progression to Rheumatoid Arthritis in Clinically Tested Cyclic Citrullinated Peptide Antibody–Positive Patients Without Rheumatoid Arthritis. Arthritis Care Res (Hoboken). 2019; 71: 1583-92. pmid:30570827 PubMed  
  15. Tilstra JS, Lienesch DW. Rheumatoid Nodules. Dermatol Clin. 2015;33(3):361-71 PubMed  
  16. Smolen JS, Landewé RBM, Bijlsma JWJ, et al. EULAR Recommendations for the Management of Rheumatoid Arthritis With Synthetic and Biological Disease-Modifying Antirheumatic Drugs: 2019 Update. Ann Rheum Dis 2020. pmid:31969328 PubMed  
  17. Combe, B., Landewe, R., Lukas, C., Bolosiu, H. D., Breedveld, F., Dougados, M., et al. 2007. EULAR recommendations for the management of early arthritis: report of a task force of the European Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis, 66, 34-45. PMID: 16396980 PubMed  
  18. Smolen JS, Aletaha D, McInnes IB. Rheumatoid arthritis. Lancet. 2016 Oct 22;388(10055):2023-2038. PMID: 27156434. PubMed  
  19. Stolt, P., et al., Quantification of the influence of cigarette smoking on rheumatoidarthritis: results from a population based case-control study, using incident cases.Ann Rheum Dis, 2003. 62(9): p. 835-41. PMID: 12922955 PubMed  
  20. Westhoff G, Rau R, Zink A. Rheumatoid arthritis patients who smoke have a higher need for DMARDs and feel worse, but they do not have more joint damage than non-smokers of the same serological group. Rheumatology 2008;47:849-54. PMID: 18390589 PubMed  
  21. Mattey, D. L., Brownfield, A., Dawes, P. T. Relationship between pack-year history of smoking and response to tumor necrosis factor antagonists in patients with rheumatoid arthritis. J Rheumatol, 2009;36: 1180-7. PMID: 19447930 PubMed  
  22. Gonzalez A, Maradit Kremers H, Crowson CS, Ballman KV, Roger VL, Jacobsen SJ, O’Fallon WM, Gabriel SE: Do cardiovascular risk factors confer the same risk for cardiovascular outcomes in rheumatoid arthritis patients as in non-rheumatoid arthritis patients? Ann Rheum Dis 2008, 67:64-69. PMID: 17517756 PubMed  
  23. Swärdh E, Brodin N. Effects of aerobic and muscle strengthening exercise in adults with rheumatoid arthritis: a narrative review summarising a chapter in Physical activity in the prevention and treatment of disease (FYSS 2016). Br J Sports Med. 2016 Mar;50(6):362-7. pmid: 26843536. PubMed  
  24. Nasjonal veileder i revmatologi. Revmatoid artritt. Norsk revmatologisk forening. Publisert 15.10.2021. Siden besøkt 06.07.2022 norskrevmatologi.no  
  25. Park JK, Lee YJ, Shin K et al. Impact of temporary methotrexate discontinuation for 2 weeks on immunogenicity of seasonal influenza vaccination in patients with rheumatoid arthritis: a randomised clinical trial. Ann Rheum Dis. 2018 Jun;77(6):898-904. doi: 10.1136/annrheumdis-2018-213222. Epub 2018 Mar 23. PMID: 29572291 PubMed  
  26. Turesson, C., O'Fallon, W. M., Crowson, C. S., Gabriel, S. E., Matteson, E. L. Extra-articular disease manifestations in rheumatoid arthritis: incidence trends and risk factors over 46 years. Ann Rheum Dis 2003; 62:722-7. PubMed  
  27. Huang S, Doyle TJ, Hammer MM, et al. Rheumatoid arthritis-related lung disease detected on clinical chest computed tomography imaging: Prevalence, risk factors, and impact on mortality. Semin Arthritis Rheum 2020; 50:1216. PMID: 33059295 PubMed  
  28. Roubille C, Richer V, Starnino T, et al. The effects of tumour necrosis factor inhibitors, methotrexate, non-steroidal anti-inflammatory drugs and corticosteroids on cardiovascular events in rheumatoid arthritis, psoriasis and psoriatic arthritis: a systematic review and meta-analysis. Ann Rheum Dis. 2015 Mar;74(3):480-9. doi: 10.1136/annrheumdis-2014-206624. PMID: 25561362 PubMed  
  29. Lindhardsen J, Ahlehoff O, Gislason GH, et al. The risk of myocardial infarction in rheumatoid arthritis and diabetes mellitus: a Danish nationwide cohort study. Ann Rheum Dis 2011; 70: 929-934. PubMed  
  30. Mantel A, Holmqvist M, Andersson DC et al. Association Between Rheumatoid Arthritis and Risk of Ischemic and Nonischemic Heart Failure. J Am Coll Cardiol 2017; 69(10): 1275-85. pmid:28279294 PubMed  
  31. George MD, Baker JF, Winthrop K, Hsu JY, Wu Q, Chen L, Xie F, Yun H, Curtis JR. Risk for Serious Infection With Low-Dose Glucocorticoids in Patients With Rheumatoid Arthritis : A Cohort Study. Ann Intern Med. 2020 Dec 1;173(11):870-878. doi: 10.7326/M20-1594. Epub 2020 Sep 22. PMID: 32956604 PubMed  
  32. Atzeni F, Turiel M, Caporali R, et al. The effect of pharmacological therapy on the cardiovascular system of patients with systemic rheumatic diseases. Autoimmun Rev 2010; 9: 835-9. PubMed  
  • Anna Nager, docent och specialist i allmänmedicin, Karolinska institutet