Inflammation

Rheumatoid Arthritis in Adults

Nathan Hinkle — Fri, 11 Sep 2026 05:00:00 +0000

Date Added:

September 11, 2026

Journal/Publication:

JAMA

Publisher:

The American Medical Association

Publication Date:

September 10, 2026

Pages:

E1-E15

URL:

Rheumatoid Arthritis in Adults A Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

doi: 10.1001/jama.2026.15455

Keywords

Arthritis, Rheumatoid

MeSH

RPR Commentary: A review of what we currently understand about rheumatoid arthritis in adults. James W. Mold, MD, MPH

Free full text

View

Importance Rheumatoid arthritis (RA) is a chronic autoimmune disease that causes inflammation and destruction of cartilage and adjacent bone and can lead to irreversible disability. Rheumatoid arthritis affects 0.53% of adults worldwide and 0.74% of US adults.

Observations Rheumatoid arthritis is more common among females than males (2:1) and has a peak incidence at ages 55 to 75 years. Rheumatoid arthritis can affect all synovial joints, and extra-articular involvement may include rheumatoid nodules, vasculitis, and rheumatoid lung disease. At diagnosis, approximately 40% to 60% of patients have autoantibodies (eg, rheumatoid factor and/or anticitrullinated peptide antibodies). There are no formal diagnostic criteria for RA, so the diagnosis is based on clinical history, characteristic joint swelling in proximal interphalangeal, metacarpophalangeal, and/or wrist joints and often presence of autoantibodies and elevated C-reactive protein levels. Early diagnosis, ideally within 6 weeks of symptom onset, allows rapid initiation of therapy with disease-modifying antirheumatic drugs (DMARDs), which inhibit inflammation and decrease the risk of joint destruction. The goal of treatment is to achieve at least 50% improvement in disease activity by 3 months and remission or low disease activity at 6 months, measured by validated indexes such as the Clinical Disease Activity Index (CDAI). The European Alliance of Associations for Rheumatology recommends starting treatment with methotrexate, 7.5 mg to 10 mg orally weekly, increasing to 20 mg to 25 mg weekly within 4 to 8 weeks, and considering addition of short-term glucocorticoids (eg, prednisone, 5-7.5 mg/d), tapered and discontinued within 3 months, or 1 intramuscular injection of 80 mg to 160 mg depot methylprednisolone. For patients with contraindications to methotrexate, sulfasalazine (2-4 g/d) or leflunomide (20 mg/d) is recommended. With treatment, about 40% of patients with newly diagnosed RA achieve CDAI remission within 6 months. Patients who do not achieve remission with first-line DMARDs should be prescribed biological DMARDs (eg, tumor necrosis factor α inhibitors, costimulation inhibitors, interleukin 6 receptor inhibitors, anti-CD20–targeting B cells), or Janus kinase (JAK) inhibitors (in patients not at high risk of thromboembolism, cardiovascular disease, or malignancy). With addition of biological DMARDs or JAK inhibitors to first-line DMARDs, overall remission or low disease activity rates increase to approximately 80%.

Conclusions and Relevance Rheumatoid arthritis is a chronic autoimmune disease that causes joint destruction. First-line initial therapy is methotrexate, with consideration of glucocorticoids as additive therapy. For patients who do not achieve remission with this initial treatment, adding biological DMARDs or JAK inhibitors increases overall remission or low disease activity rates to 80%.

Author/s:

Josef S. Smolen, Andreas Kerschbaumer, Daniel Aletaha

Uveitis in Adults

Hope Smashey — Tue, 01 Jul 2025 17:07:23 +0000

Date Added:

July 1, 2025

Journal/Publication:

JAMA

Publication Date:

May 28, 2025

URL:

Uveitis in Adults

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2025.4358

Keywords

human leukocyte antigen

PMID (1):

40434762

MeSH

human leukocyte antigen

corticosteroid

antimicrobial

Inflammation

An evidence-based review of the diagnosis, causes, and treatment of uveitis in adults. James W. Mold, MD, MPH

View

Importance: Uveitis is characterized by inflammation of the uvea—the middle portion of the eye composed of the iris, ciliary body, and choroid—causing eye redness, pain, photophobia, floaters, and blurred vision. Untreated uveitis may cause cataracts, glaucoma, macular edema, retinal detachment, optic nerve damage, and vision loss.

Observations: Uveitis predominantly affects individuals aged 20 to 50 years. Anterior uveitis affects the iris and ciliary body (41%-60% of cases); intermediate uveitis affects the pars plana (attachment point of vitreous humor) and peripheral retina (9%-15%); posterior uveitis involves the choroid and/or retina (17%-23%); and panuveitis involves all uveal layers (7%-32%). Uveitis is classified as noninfectious or infectious, with toxoplasmosis, herpes, tuberculosis, and HIV comprising 11% to 21% of infectious cases in high-income countries and 50% in low- and middle-income countries. Incidence and prevalence of uveitis are influenced by genetic factors (eg, human leukocyte antigen–B27), environmental factors (eg, air pollution), and infection rates. In the US and Europe, 27% to 51% of uveitis cases are idiopathic, and 37% to 49% are associated with systemic disease, such as axial spondyloarthritis. Treatment goals are to induce and maintain remission while minimizing corticosteroid use to reduce corticosteroid-related adverse effects. Infectious uveitis requires systemic antimicrobial treatment. Active inflammatory disorders associated with uveitis should be treated by the appropriate specialist (eg, rheumatologist). Treatment for uveitis depends on subtype; anterior uveitis is treated with topical corticosteroids, and mild intermediate uveitis may be monitored without initial treatment. Patients with moderate to severe intermediate uveitis, posterior uveitis, and panuveitis are at high risk of sight-threatening complications and require systemic and/or intravitreal corticosteroids and immunosuppressive agents. For posterior uveitis, first-line therapy with disease-modifying antirheumatic drugs such as methotrexate achieved remission of inflammation in 52.1% (95% CI, 38.6%-67.1%) of patients, and mycophenolate mofetil controlled inflammation in 70.9% (95% CI, 57.1%-83.5%). In patients who do not improve or worsen with first-line therapy, adalimumab extended time to treatment failure to 24 weeks vs 13 weeks with placebo and reduced frequency of treatment failure from 78.5% to 54.5% (P < .001).

Conclusions and Relevance: Uveitis is characterized by inflammation of the uvea and primarily affects adults aged 20 to 50 years. For noninfectious anterior uveitis, corticosteroid eyedrops are first-line treatment. For posterior noninfectious uveitis, disease-modifying antirheumatic drugs are first-line therapy; biologics such as adalimumab are second-line treatment for patients with inflammation refractory to treatment. Uveitis caused by systemic infection should be treated with antimicrobials, and local or systemic steroids may be used depending on the severity of uveitis and the specific microorganism.

Author/s:

Panayiotis Maghsoudlou, Simon J. Epps, Catherine M. Guly

Topical nonsteroidal anti-inflammatory drugs

Rowan Hutchins — Tue, 03 Oct 2023 05:00:00 +0000

Date Added:

October 3, 2023

Journal/Publication:

CMAJ

Publisher:

CMA

Publication Date:

September 18, 2023

Issue:

Volume:

195

URL:

Topical nonsteroidal anti-inflammatory drugs

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1503/cmaj.230578

Keywords

Inflammation

NSAID

PMID (1):

37722741

MeSH

Anti-Inflammatory Agents

Non-Steroidal*

A concise review of the evidence supporting the effectiveness and safety of topical NSAIDS. James W. Mold, MD, MPH

Free full text

View

Topical nonsteroidal anti-inflammatory drugs (NSAIDs) provide local analgesia and anti-inflammatory effects with minimal systemic uptake
Nonsteroidal anti-inflammatory drugs inhibit the cyclooxygenase enzyme, reducing inflammation and pain. Compared with oral formulations, topical NSAIDs work locally, with systemic uptake limited to around 5%.1 High-quality evidence supports the analgesic role of several topical NSAIDs, including diclofenac and ketoprofen.1 Salicylate-containing rubefacients are excluded from this discussion given their distinct mechanism of action.

Author/s:

Bhat, Chirag, Rosenberg, Hans, James, Daniel

Diagnosis and management of endometriosis

Rowan Hutchins — Sun, 19 Mar 2023 05:00:00 +0000

Date Added:

March 19, 2023

Journal/Publication:

CMAJ

Publisher:

Canadian Medical Association

Publication Date:

March 14, 2023

Issue:

Volume:

195

Pages:

E363-E371

URL:

Diagnosis and management of endometriosis

Type:

Meta-analyses, Reviews, and Guidelines

DOI (1):

10.1503/cmaj.220637

Keywords

PMID (1):

36918177

MeSH

A concise summary of what we know about endometriosis. James W. Mold, MD, MPH

Free full text

View

Endometriosis is a chronic condition defined by the presence of endometrial-like tissue outside of the uterus, which can lead to estrogen-driven inflammation. The extent of disease can be highly variable, ranging from minimal peritoneal deposits to deep disease that can invade into the bowel, bladder and ureter and, more rarely, spread to extrapelvic (e.g., cutaneous, thoracic) sites. Endometriosis is a complex disease that has considerable impact on the quality of life of those affected and that has no cure. It remains poorly understood. We review the epidemiology, pathophysiology, diagnosis and management of endometriosis, based on the best available evidence and clinical guidelines

Author/s:

Allaire, Catherine, Bedaiwy, Mohamed, Yong, Paul

Interventions for hand eczema

Brian Desmarais — Wed, 05 Jun 2019 20:27:09 +0000

Date Added:

June 5, 2019

Journal/Publication:

Cochrane Systematic Review

Publication Date:

April 26, 2019

URL:

Interventions for hand eczema

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1002/14651858.CD004055.pub2.

Keywords

MeSH

Calcineurin Inhibitors/therapeutic use

Eczema/drug therapy

Emollients/therapeutic use

Immunosuppressive Agents/therapeutic use

Severity of Illness Index

Emollients

A Cochrane review of current RCT evidence regarding treatment of hand eczema. James W. Mold, MD, MPH

Free full text

View

Abstract

BACKGROUND:

Hand eczema is an inflammation of the skin of the hands that tends to run a chronic, relapsing course. This common condition is often associated with itch, social stigma, and impairment in employment. Many different interventions of unknown effectiveness are used to treat hand eczema.

OBJECTIVES:

To assess the effects of topical and systemic interventions for hand eczema in adults and children.

SEARCH METHODS:

We searched the following up to April 2018: Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, Embase, AMED, LILACS, GREAT, and four trials registries. We checked the reference lists of included studies for further references to relevant trials.

SELECTION CRITERIA:

We included randomised controlled trials (RCTs) that compared interventions for hand eczema, regardless of handeczema type and other affected sites, versus no treatment, placebo, vehicle, or active treatments.

DATA COLLECTION AND ANALYSIS:

We used standard methodological procedures expected by Cochrane. Primary outcomes were participant- and investigator-rated good/excellent control of symptoms, and adverse events.

Author/s:

Christoffers, W.A., Coenraads, P.J., Svensson, Å., Diepgen, T.L., Dickinson-Blok, J.L., Williams, H.C., Xia, J.