EULAR points to consider for the management of difficult-to-treat-rheumatoid arthritis
(Part 6)
Allow me to discuss some of the points to consider as formulated by the task force of the European Alliance of Associations for Rheumatology (EULAR).
As mentioned in earlier parts of this series, the European Alliance of Associations for Rheumatology (EULAR) has come up with several points to consider (PtC) for doctors when treating difficult to treat rheumatoid arthritis (D2T RA). The first PtC states that the doctor should look into the possibility of another existing illness aside from the D2T RA. The doctor should order tests for other diseases to avoid misdiagnosis. This should be the initial step the doctor should make in the treatment process.
It is possible that misdiagnosis of a disease is common and should be considered in treating RA and should be considered in all RA patients.
Other diseases that may be misdiagnosed include: crystal arthropathies, polymyalgia
rheumatica, psoriatic arthritis, spondyloarthritis, Still’s disease, systemic lupus erythematosus, Rhupus (RA–lupus) syndrome, idiopathic inflammatory myopathies, vasculitis, remitting symmetric seronegative synovitis and pitting oedema, reactive arthritis, rubella, Whipple’s disease and hepatitis B virus (HBV) and hepatitis C virus (HCV) infections), paraneoplastic syndromes, osteoarthritis and fibromyalgia.
Furthermore, there could be other conditions that might coexist and suggest the presence of RA.
It is possible for misdiagnosis to happen because of certain signs and symptoms of D2T RA.
It is important to detect the diseases early in order to optimize the treatment using disease modifying anti-rheumatism drugs (DMARDS.
Another PtC states that where there is doubt on the presence of inflammatory activity based on the assessment and composite indices, ultrasonography (US) may be considered for this evaluation.
The EULAR said that this PtC is related to the methods used in assessing the presence of inflammatory disease activity.
The use of rational measures may show difficulty in finding out whether or not there is a presence of inflammation.
The use of US may help detect inflammatory activity both in patients with D2T RA in general and in those with other conditions such as obesity or concomitant fibromyalgia.
There are other PtC provided by the EULAR’s task force, and we will tackle some of them in next week’s column