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Advances in rheumatoid arthritis

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This narrative review summarises the literature on contemporary understanding of adult rheumatoid arthritis (RA) focusing on current therapy, especially biological therapy. Articles were progressively identified by hand searching the list of contents in leading general and rheumatology journals, on a monthly basis over the past 6 years.

RA is a relatively common inflammatory arthritis (Box 1) and is self-reported by 2% of the Australian population (http://www.aihw.gov.au/rheumatoid-arthritis). It is diagnosed based on four criteria: number and pattern of joints involved, disease duration greater than 6 weeks, raised inflammatory markers (such as erythrocyte sedimentation rate [ESR] or C-reactive protein [CRP] level) and positive serology (the well established rheumatoid factor or the newer cyclic citrullinated peptide antibody [CCP])1 — CCP appears to be pathogenic and can be produced in gingival and lung tissues.2 RA cannot be diagnosed with only one involved joint. While there is considerable variation, either antibody is positive in about 50% of patients at presentation, with some overlap making about 25% seronegative. These antibodies are commonly misused in clinical practice, and their use should be restricted to patients with symptoms of inflammatory arthritis, especially…