Rheumatoid arthritis (RA) is a chronic autoimmune disease producing damage to joint tissues mediated by inflammatory chemicals, such as cytokines, TNF-alpha, and metalloproteinases. It is a progressive disease often resulting in symmetrical inflammation affecting the synovial membranes of peripheral joints (e.g., wrists and metacarpophalangeal joints), destruction of articular cartilage and bone, and deformities of the affected joints.
Treatment of rheumatoid arthritis includes a disease-modifying antirheumatic drug (DMARD) in combination with a nonsteroidal anti-inflammatory drug (NSAID) or a glucocorticoid. Methotrexate is generally the DMARD of choice (Table 19).17 If the response to a DMARD is inadequate, a TNF-alpha inhibitor such as adalimumab (Humira) is added to the regimen. The risk of a MME is predicated on adverse drug effects and/or other concurrent variables.42