The diagnostic criteria established by the American College of Rheumatology include prolonged morning stiffness in the joints, characteristic nodules under the skin, joint erosions apparent on X-ray tests, and blood tests of an antibody known as rheumatoid factor. Successful management of RA requires early diagnosis and aggressive treatment before functional impairment and irreversible joint damage has occurred. These drugs include methotrexate, hydroxychloroquine, sulfasalzine, corticosteroids, intramuscular and oral gold, d-penicillamine, minocycline, azathioprine, cyclosporine, leflunomide, and etanercept. Optimal treatment requires comprehensive coordinated care, patient education and the expertise of a number of providers, including rheumatologists, primary care physicians, nurses, occupational and physical therapists, physiatrists and orthopedic surgeons. The chronic nature of RA and the diagnostic and treatment complexity have made the rheumatologist s special skills and training critically important in the care of people with this disease.
Expertise is needed to balance the risks and benefits of disease-modifying drugs.