A Review of Rheumatoid Arthritis for Pharmacists

Rheumatoid arthritis (RA) is caused by an autoimmune response in which the immune system attacks the synovial tissues of the joints and other tissues. Therapy focuses on a treat- to- target approach, usually involving the initiation and titration of disease-modifying antirheumatic drugs (DMARDs) with a goal of disease remission or significant symptom alleviation, depending on the severity. Methotrexate is the recommended DMARD for initiation in most patients, although its use depends on individual patient characteristics and shared decision making. Adding other DMARDs, including biological agents, may be considered as treatment progresses. Given the complicated dosing, adverse-event profiles, and potentially high costs associated with RA pharmacotherapy, pharmacists can perform useful services for both patients and prescribers.