Arthritis, Rheumatoid

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

Evaluating Inflammatory Joint Pain in Older Adults-Practical Diagnostic Clues for Primary Care Clinicians

Nathan Hinkle — Wed, 17 Jun 2026 00:59:54 +0000

Date Added:

June 16, 2026

Journal/Publication:

JAMA Intern Med

Publisher:

The American Medical Association

Publication Date:

June 8, 2026

URL:

Evaluating Inflammatory Joint Pain in Older Adults-Practical Diagnostic Clues for Primary Care Clinicians

Type:

Meta-analyses, Reviews, and Guidelines

CME Credits:

Format:

Article

DOI (1):

doi: 10.1001/jamainternmed.2026.2032

Keywords

Arthritis, Rheumatoid

MeSH

RPR Commentary: A review of the evaluation of older patients with joint inflammation. James W. Mold, MD, MPH

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Arthritis is a leading cause of pain and disability that affects nearly one-third of older US adults (age ≥65 years). While osteoarthritis (OA) predominates, many have inflammatory arthritis (IA), including rheumatoid arthritis (RA), spondyloarthritis, and crystal arthropathies.1 Recognition of IA is frequently delayed for longer than a year in older adults due to atypical and overlapping presentations.2 Untreated IA can lead to irreversible damage, functional decline, and prolonged glucocorticoid exposure. Joint pain is often initially evaluated by primary care clinicians; therefore, timely recognition and early management are essential. This article highlights unique aspects of IA in older adults and offers practical guidance.

Author/s:

Jiha Lee, Justin B Levinson, Una E Makris

Risk for Serious Infection With Low-Dose Glucocorticoids in Patients With Rheumatoid Arthritis

Brian Desmarais — Tue, 29 Sep 2020 13:45:07 +0000

Date Added:

September 29, 2020

Journal/Publication:

Annals of Internal Medicine

Publication Date:

September 22, 2020

URL:

Risk for Serious Infection With Low-Dose Glucocorticoids in Patients With Rheumatoid Arthritis

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.7326/M20-1594

Keywords

Arthritis, Rheumatoid

MeSH

Antirheumatic Agents

glucocorticoids

Hormone Replacement Therapy

behavior therapy

Infections

In this 1-year cohort study, patients with rheumatoid arthritis who, in addition to DMARDS, took an oral corticosteroid were more likely to be hospitalized with a serious infection even if the dose of CS was very low (5mg a day of prednisone). One has to wonder if the same is true in patients without RA. James W. Mold, MD, MPH

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Abstract

Background: Low-dose glucocorticoids are frequently used for the management of rheumatoid arthritis (RA) and other chronic conditions, but the safety of long-term use remains uncertain.

Objective: To quantify the risk for hospitalized infection with long-term use of low-dose glucocorticoids in patients with RA receiving stable disease-modifying antirheumatic drug (DMARD) therapy.

Design: Retrospective cohort study.

Setting: Medicare claims data and Optum's deidentified Clinformatics Data Mart database from 2006 to 2015.

Patients: Adults with RA receiving a stable DMARD regimen for more than 6 months.

Measurements: Associations between glucocorticoid dose (none, ≤5 mg/d, >5 to 10 mg/d, and >10 mg/d) and hospitalized infection were evaluated using inverse probability-weighted analyses, with 1-year cumulative incidence predicted from weighted models.

Results: 247 297 observations were identified among 172 041 patients in Medicare and 58 279 observations among 44 118 patients in Optum. After 6 months of stable DMARD use, 47.1% of Medicare patients and 39.5% of Optum patients were receiving glucocorticoids. The 1-year cumulative incidence of hospitalized infection in Medicare patients not receiving glucocorticoids was 8.6% versus 11.0% (95% CI, 10.6% to 11.5%) for glucocorticoid dose of 5 mg or less per day, 14.4% (CI, 13.8% to 15.1%) for greater than 5 to 10 mg/d, and 17.7% (CI, 16.5% to 19.1%) for greater than 10 mg/d (all P < 0.001 vs. no glucocorticoids). The 1-year cumulative incidence of hospitalized infection in Optum patients not receiving glucocorticoids was 4.0% versus 5.2% (CI, 4.7% to 5.8%) for glucocorticoid dose of 5 mg or less per day, 8.1% (CI, 7.0% to 9.3%) for greater than 5 to 10 mg/d, and 10.6% (CI, 8.5% to 13.2%) for greater than 10 mg/d (all P < 0.001 vs. no glucocorticoids).

Limitation: Potential for residual confounding and misclassification of glucocorticoid dose.

Conclusion: In patients with RA receiving stable DMARD therapy, glucocorticoids were associated with a dose-dependent increase in the risk for serious infection, with small but significant risks even at doses of 5 mg or less per day. Clinicians should balance the benefits of low-dose glucocorticoids with this potential risk.

Primary funding source: National Institute of Arthritis and Musculoskeletal and Skin Diseases.

Author/s:

George, Michael D., Bake, Joshua F., Winthrop, Kevin, Hsu, Jesse Y., Wu, Qufei, Chen, Lang