Early Diagnosis

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

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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

What Parents Need to Know About Autism Screening and Early Treatment

Alex Haga — Sat, 10 Aug 2024 18:26:42 +0000

Date Added:

August 10, 2024

Journal/Publication:

JAMA

Publication Date:

August 1, 2024

URL:

What Parents Need to Know About Autism Screening and Early Treatment

Type:

Patient Education Materials

Format:

Article

DOI (1):

10.1001/jamapediatrics.2024.1324

Keywords

autism

spectrum

children

PMID (1):

38913370

MeSH

Autism Spectrum Disorder* / diagnosis

Autistic Disorder*

Early Diagnosis

Autism Spectrum Disorder* / complications

Autistic Disorder* / therapy

Information for parents about screening and treatment for autism and autism spectrum disorders. James W. Mold, MD, MPH

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This JAMA Pediatrics Patient Page describes autism screening for children and how to access therapies.

Author/s:

Vijay Vasudevan, Anne Nagel, Lindsay A Thompson

Infant with edematous, erythematous toe

Bethie Seay — Thu, 14 Oct 2021 05:00:00 +0000

Date Added:

October 14, 2021

Journal/Publication:

MDedge

Publication Date:

October 7, 2021

Type:

Meta-analyses, Reviews, and Guidelines

A picture and explanation of hair tourniquet syndrome in an infant. Worth knowing about.

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A 3-month-old baby presented with a tender and swollen fourth toe and increasing irritability. On examination, the distal portion of the digit was pale and cold to the touch. There was a delay in capillary refill time.

What’s your diagnosis?

Author/s:

Osmani, S., Stulberg, D., Osmani, O.

COVID-19–Associated Multisystem Inflammatory Syndrome in Children — United States, March–July 2020

Brian Desmarais — Tue, 11 Aug 2020 16:18:53 +0000

Date Added:

August 11, 2020

Journal/Publication:

Morbidity and Mortality Weekly Report

Publisher:

Centers for Disease Control and Prevention

Publication Date:

August 7, 2020

URL:

COVID-19–Associated Multisystem Inflammatory Syndrome in Children — United States, March–July 2020

Type:

Clinical Research Results

Format:

Article

DOI (1):

http://dx.doi.org/10.15585/mmwr.mm6932e2

MeSH

health personnel

Early Diagnosis

Public Health Practice

A summary from the CDC of what is currently known about COVID-19-related Multisystem Inflammatory Syndrome in Children (MIS-C) in the U.S. James W. Mold, MD, MPH

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Summary

What is already known about this topic?

Multisystem inflammatory syndrome in children (MIS-C) is a rare but severe condition that has been reported approximately 2–4 weeks after the onset of COVID-19 in children and adolescents.

What is added by this report?

Most cases of MIS-C have features of shock, with cardiac involvement, gastrointestinal symptoms, and significantly elevated markers of inflammation, with positive laboratory test results for SARS-CoV-2. Of the 565 patients who underwent SARS-CoV-2 testing, all had a positive test result by RT-PCR or serology.

What are the implications for public health practice?

Distinguishing MIS-C from other severe infectious or inflammatory conditions poses a challenge to clinicians caring for children and adolescents. As the COVID-19 pandemic continues to expand in many jurisdictions, health care provider awareness of MIS-C will facilitate early recognition, early diagnosis, and prompt treatment.

Author/s:

Godfred-Cato, S., Bryant, B., Leung, J.