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J Korean Med Assoc > Volume 52(7); 2009 > Article
Ko and Kim: Recent Advance in Rheumatoid Arthritis

Abstract

Rheumatoid arthritis is a systemic, inflammatory, autoimmune disorder of unknown origins. Enhanced understanding of molecular pathogenesis has enabled the development of new biologic treatment that focuses on selective parts of immune system. Combined genetic and environmental factors in association with the risk of rheumatoid arthritis have received increased attention. Research undertaken on the longitudinal disease process and molecular pathology of joint inflammation has contributed to the development of new therapeutic strategies that promote early use of disease-modifying anti-rheumatic drugs (DMARDs) with tight disease control and measurable treatment outcome. Such approach can be beneficial for control of inflammatory activity and joint destruction. We need to find out how to tailor the best individualized treatment in accordance with different cases.

Figure 1.
Longitudinal course of rheumatoid arthritis.
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Figure 2.
Immunological pathway of rheumatoid arthritis.
jkma-52-657f2-l.jpg
Figure 3.
Mode of action of targeted treatments.
jkma-52-657f3-l.jpg
Table 1.
ACR criteria for rheumatoid arthritis
1. Morning stiffness lasting at least 1h, present for at least 6 weeks
2. At least three joint areas simultaneously with soft-tissue swelling or fluid, for at least 6 weeks
3. At least one area swollen in a wrist, metacarpophalangeal, or proximal interphalangeal joint, for at least 6 weeks
4. Simultaneously involvement of the same joint areas on both sides of the body, for at least 6 weeks
5. Subcutaneous nodules seen by a doctor
6. Positive rheumatoid factor
7. Radiographic changes on hand and wrist radiographs (erosions or unequivocal bony decalcification)

A patient is said to have rheumatoid arthritis if he or she meets at least four criteria. Patients with two clinical diagnoses are not excluded.

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