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Rheumatoid arthritis (RA) is a common disabling systemic inflammatory disorder that causes chronic joint destruction. However, by most assessments, the consequences of treated disease have become less severe during the past 20 years. An armamentarium of second-line drugs, including methotrexate and biologic agents such as tumor necrosis factor (TNF) inhibitors, in combination with widely accepted treatment strategies, which include early treatment and treatment that targets low disease activity,1 has led to a reduction in disease activity for patients with RA throughout much of the developed world.2 Despite highly effective treatments, approximately 20% of patients continue to experience pain, disability, and joint destruction. In addition, even with effective treatment, RA has been linked to increased cardiovascular mortality,3 perhaps because of long-standing high levels of systemic inflammation. The residual disease activity among patients whose disease is difficult to manage and the associated cardiovascular mortality remain important management challenges.
Felson DT, Klareskog L. The Genetics of Rheumatoid ArthritisNew Insights and Implications. JAMA. 2015;313(16):1623-1624. doi:10.1001/jama.2015.1710