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ID PMID Title PublicationDate abstract
25836637 Histopathology of lung disease in the connective tissue diseases. 2015 May The pathologic correlates of interstitial lung disease (ILD) secondary to connective tissue disease (CTD) comprise a diverse group of histologic patterns. Lung biopsies in patients with CTD-associated ILD tend to demonstrate simultaneous involvement of multiple anatomic compartments of the lung. Certain histologic patterns tend to predominate in each defined CTD, and it is possible in many cases to confirm connective tissue-associated lung disease and guide patient management using surgical lung biopsy. This article will cover the pulmonary pathologies seen in rheumatoid arthritis, systemic sclerosis, myositis, systemic lupus erythematosus, Sjögren syndrome, and mixed CTD.
28064091 Dose-response characteristics of Clematis triterpenoid saponins and clematichinenoside AR 2017 Mar 20 Clematidis Radix et Rhizoma is a traditional Chinese medicine widely used for treating arthritic disease. Clematis triterpenoid saponins (TS) and clematichinenoside AR (C-AR) have been considered to be responsible for its antiarthritic effects. However, the underling mechanism is still unclear because of their low bioavailability. To address of this issue, metabolomics tools were performed to determine metabolic variations associated with rheumatoid arthritis (RA) and responses to Clematis TS, C-AR and positive drug (Triptolide, TP) treatments. This metabolomics investigation of RA was conducted in collagen-induced arthritis (CIA) rats. Liquid chromatography/mass spectrometry and multivariate statistical tools were used to identify the alteration of serum and urine metabolites associated with RA and responses to drug treatment. As a result, 45 potential metabolites associated with RA were identified. After treatment, a total of 24 biomarkers were regulated to normal like levels. Among these, PC(18:0/20:4), 9,11-octadecadienoic acid, arachidonic acid, 1-methyladenosine, valine, hippuric acid and pantothenic acid etc, were reversed in Clematis TS and C-AR groups. Tetrahydrocortisol was regulated to normal levels in Clematis TS and TP groups, while 3,7,12-trihydroxycholan-24-oic acid was regulated in C-AR and TP groups. Biomarkers like citric acid, p-cresol glucuronide, creatinine, cortolone were reversed in TP group.
27366177 Rat Bite Fever Resembling Rheumatoid Arthritis. 2016 Rat bite fever is rare in Western countries. It can be very difficult to diagnose as blood cultures are typically negative and a history of rodent exposure is often missed. Unless a high index of suspicion is maintained, the associated polyarthritis can be mistaken for rheumatoid arthritis. We report a case of culture-positive rat bite fever in a 46-year-old female presenting with fever and polyarthritis. The clinical presentation mimicked rheumatoid arthritis. Infection was complicated by discitis, a rare manifestation. We discuss the diagnosis and management of this rare zoonotic infection. We also review nine reported cases of rat bite fever, all of which had an initial presumptive diagnosis of a rheumatological disorder. Rat bite fever is a potentially curable infection but can have a lethal course if left untreated.
27417758 Vitamin D as an Immunomodulator: Risks with Deficiencies and Benefits of Supplementation. 2015 Apr 14 Vitamin D refers to a class of fat-soluble secosteroids often associated with their role in absorption and metabolism of minerals such as calcium and phosphate. In recent years, our understanding of vitamin D has expanded to include its role in modulating the immune system. Of particular focus are the effects of vitamin D deficiency and supplementation on patients suffering from disorders due to dysregulation of the immune system. In patients with multiple sclerosis, rheumatoid arthritis, and inflammatory bowel disease, deficiencies in vitamin D have been associated with an increased risk of disease activity. In this review, we will look at the current state of research in regards to the relationship between vitamin D and immune-dysregulation. We will focus on both the risks associated with vitamin D deficiency as well as the benefits of vitamin D supplementation.
25674181 Comparisons of Body Image Perceptions of a Sample of Black and White Women with Rheumatoid 2015 OBJECTIVE: To explore the disease-related, body image (BI) perceptions of women diagnosed with, rheumatoid arthritis (RA) and fibromyalgia (FM). METHODS: A purposive sample of twenty-seven females participated in individual semi-structured phone interviews to elicit BI perceptions relative to pain, activity limitations and coping measures. Sessions were digitally recorded, transcribed verbatim, and content analyzed. RESULTS: Body image perceptions relative to 5 major themes emerged in the analysis. They focused on Pain, Disease Impact on Physical and Mental Function, Weight, Diseased-Induced Fears and, Coping measures. Pain was a common experience of all participants. Other troubling factors verbalized by participants included dislike and shame of visibly affected body parts, and disease-induced social, psychological and physical limitations. RA participants thought that manifested joint changes, such as swelling and redness, undergirded their prompt diagnosis and receipt of health care. Contrarily, women with fibromyalgia perceived that the lack of visible, disease-related, physical signs led to a discounting of their disease, which led to delayed health care and subsequent frustrations and anger. All but one participant used prayer and meditation as a coping measure. CONCLUSION: The body image perceptions evidenced by the majority of participants were generally negative and included specific focus on their disease-affected body parts (e.g. joints), mental function, self-identity, health care experiences, activity limitations and overall quality of life. Given the global effect of RA and FM, assessment and integration of findings about the BI perceptions of individuals with FM and RA may help define suitable interdisciplinary strategies for managing these conditions and improving participants' quality of life.
28070410 Depression and anxiety after 2 years of follow-up in patients diagnosed with diabetes or r 2016 Jul We studied emotional health in patients with diabetes mellitus (n = 89) or rheumatoid arthritis (n = 100) aged 18-65 years, at the time of diagnosis and after 24 months. Predictors for depression or anxiety according to the Hospital Anxiety and Depression scale after 2 years were assessed by logistic regression, with psychosocial factors and coping as dependent factors. There were many similarities between patients with diabetes mellitus or rheumatoid arthritis. Having children at home, low score on the Sense of Coherence scale, and high score on the coping strategy "protest" were important risk factors for depression and anxiety after 2 years.
26903079 Lipopolysaccharides attenuates growth of HS cells through the JNK pathway. 2016 Dec Rheumatoid arthritis is characterized by inflammation of the synovial membrane, which can result in joint destruction within the first few years after onset. Lipopolysaccharides (LPS) are glycolipids found in abundance on the outer membranes of all Gram-negative bacteria and incite a vigorous inflammatory response. We studied the potential involvement of mitogen-activated protein kinase serine/threonine kinases in LPS-induced growth of HS synovial cells. Various concentrations of LPS were applied to cultured HS cells and growth rate, as well as changes in the phosphorylation states of extracellular regulated kinase 1/2, Jun N-terminal kinase (JNK), and p38 were determined. As results, growth of LPS-treated HS cells was inhibited primarily by phosphorylated JNK and this phosphorylation was mediated by the LPS receptor. Our results suggest that LPS inhibits growth of HS cells primarily through the JNK pathway.
26862312 The role of natural killer cells in pathogenesis of autoimmune diseases. 2015 There is growing evidence that NK cell-mediated immunoregulation plays an important role in the control of autoimmunity. NK cells are a subset of lymphocytes that generally contribute to innate immunity but have also a great impact on the function of T and B lymphocytes. The major role of NK cells is cytotoxic reaction against neoplastic, infected and autoreactive cells, but they regulatory function seems to play more important role in the pathogenesis of autoimmune diseases. Numerous studies suggested the involvement of NK cells in pathogenesis of such a common autoimmune diseases as juvenile rheumatoid arthritis, type I diabetes and autoimmune thyroid diseases. The defects of NK cells regulatory function as well as cytotoxic abilities are common in patients with autoimmune diseases with serious consequences including HLH hemophagocytic lymphocytosis (HLH) and macrophage activation syndrome (MAS). The early diagnosis of NK cells defect responsible for the loss of the protective abilities is crucial for the prevention of life-threatening complications and implementation of necessary treatment.
26548348 Pristimerin inhibits angiogenesis in adjuvant-induced arthritic rats by suppressing VEGFR2 2015 Dec Rheumatoid arthritis (RA) is a progressive, inflammatory autoimmune disease. As RA progresses, the hyperplastic synovial pannus creates a hypoxic, inflammatory environment that induces angiogenesis. Further vascularization of the synovial tissue promotes pannus growth and continued infiltration of inflammatory leukocytes, thus perpetuating the disease. Pristimerin inhibits inflammation and tumor angiogenesis. The present study focused on the inhibition of angiogenesis by Pristimerin in adjuvant-induced arthritic rats and the underlying molecular mechanisms. Our results clearly demonstrate for the first time that Pristimerin significantly reduces vessel density in synovial membrane tissues of inflamed joints and reduces the expression of pro-angiogenic factors in sera, including TNF-α, Ang-1, and MMP-9. Pristimerin also decreased the expression of VEGF and p-VEGFR2 in the synovial membrane, whereas the total amount of VEGFR2 remained unchanged. Pristimerin suppressed the sprouting vessels of the aortic ring and inhibited VEGF-induced HFLS-RA migration in vitro. Pristimerin also inhibited VEGF-induced proliferation, migration and tube formation by HUVECs, blocked the autophosphorylation of VEGF-induced VEGFR2 and consequently downregulated the signaling pathways of activated PI3K, AKT, mTOR, ERK1/2, JNK, and p38 in VEGF-induced HUVECs. Our results indicate that Pristimerin suppressed synovial angiogenesis in our rat model and in vitro by interrupting the targeting of VEGFR2 activation. Therefore, Pristimerin has potential as an angiogenesis inhibitor in the treatment of rheumatoid arthritis.
25712857 Leflunomide and teriflunomide: altering the metabolism of pyrimidines for the treatment of 2015 May Leflunomide modulates T-cell responses and induces a shift from the Th1 to Th2 subpopulation. This process results in a beneficial effect in diseases in which there is good evidence that T cells play a major role in both initiation and perpetuation of the inflammatory condition. Leflunomide has been successfully used for treating rheumatoid arthritis and psoriatic arthritis for many years. The active metabolite of leflunomide is teriflunomide, which has been approved for treating multiple sclerosis. Teriflunomide, just like the mother drug, inhibits dihydro-orotate dehydrogenase and synthesis of pyrimidine. The present review presents and discusses the safety profiles of leflunomide and teriflunomide, two drugs that are indeed the same, considering that much can be learned from the reported side effects of both.
27213943 [The influence of chronomagnetic therapy on the parameters of the quality of life in the p 2016 Mar The methods for the rehabilitative treatment play an important role in the management of the patients presenting with the diseases of the musculoskeletal system. One of these techniques is chronomagnetic therapy. AIM: The objective of the present study was to evaluate the influence of chronomagnetic therapy on the patient's quality of life. PATIENTS AND METHODS: The patients of the main group included 30 ones with osteoarthrosis, 30 with rheumatoid arthritis, 20 with ankylosing spondylitis, 6 with podagric arthritis, 6 with psoriatic arthritis, and 6 others with reactive arthritis. Each of these patients every day underwent 10 sessions of chronomagnetic therapy with the use of the Multimag apparatus («Kasimov Instrumental Plant», Ryazan). The patients of the comparison group (20 ones presenting with osteoarthrosis, 27 with rheumatoid arthritis, 15 with ankylosing spondylitis, 4 with podagric arthritis, 4 with psoriatic arthritis, and 4 subjects with reactive arthritis) received the identical chronomagnetotherapeutic treatment under the conditions of the «Vulan» balneological health resort located at Gelendzhik, Krasnodar Region. RESULTS: The patients of the main group presenting with osteoarthrosis were characterized by the most pronounced manifestations of the role physical and social behaviour and the associated enhancement of pain intensity. The patients with rheumatoid arthritis exhibited well apparent manifestation of role and emotional functioning as well as enhanced vitality. Positive dynamics of these characteristics (role physical and emotional functioning, vital activity) was documented in the patients of the comparison group presenting with osteoarthrosis, ankylosing spondylitis, and rheumatoid arthritis. In this group, the patients with osteoarthrosis, ankylosing spondylitis, and rheumatoid arthritis experienced the improvement of the major parameters of the quality of life characterizing the physical and mental components of the health status. CONCLUSION: The chronomagnetotherapeutic treatment at the stage of rehabilitation of the patients suffering from the diseases of the musculoskeletal system markedly improves the characteristics of physical health the disturbances of which may lead to the development of psycho-somatic disorders. Chronomagnetic therapy of the patients with the diseases of the musculoskeletal system under the conditions of a balneological health resort proved to be more effective in terms of improvement of the parameters of physical and mental health. The result of the subjective evaluation of the health status in such patients can be used as a marker of the effectiveness of chronomagnetic therapy and an indicator of remission of the disease.
27895639 NETosis as Source of Autoantigens in Rheumatoid Arthritis. 2016 In neutrophils (but also in eosinophils and in mast cells), different inflammatory stimuli induce histone deimination, chromatin decondensation, and NET formation. These web-like structures that trap and kill microbes contain DNA, cationic granule proteins, and antimicrobial peptides, but the most abundant proteins are core histones. Histones contained in NETs have been deiminated, and arginines are converted in citrullines. While deimination is a physiological process amplified in inflammatory conditions, only individuals carrying genetic predisposition to develop rheumatoid arthritis (RA) make antibodies to deiminated proteins. These antibodies, collectively identified as anti-citrullinated proteins/peptides antibodies (ACPA), react with different deiminated proteins and display partially overlapping specificities. In this paper, we will summarize current evidence supporting the role of NETosis as critical mechanism in the breach of tolerance to self-antigens and in supporting expansion and differentiation of autoreactive cells. In fact, several lines of evidence connect NETosis with RA: RA unstimulated synovial fluid neutrophils display enhanced NETosis; sera from RA patients with Felty's syndrome bind deiminated H3 and NETs; a high number of RA sera bind deiminated H4 contained in NETs; human monoclonal antibodies generated from RA synovial B cells decorate NETs and bind deiminated histones. In RA, NETs represent on one side an important source of autoantigens bearing posttranslational modifications and fueling the production of ACPA. On the other side, NETs deliver signals that maintain an inflammatory milieu and contribute to the expansion and differentiation of ACPA-producing B cells.
26622411 RANKL, OPG and CTR mRNA expression in the temporomandibular joint in rheumatoid arthritis. 2015 Sep The calcitonin receptor (CTR) and receptor activator of nuclear factor κB ligand (RANKL) have been found to be involved in the differentiation of osteoclasts. The association between the RANKL:osteoprotegerin (OPG) expression ratio and the pathogenesis of bone-destructive rheumatoid arthritis (RA) has been described in several joints, but the available data for the temporomandibular joint (TMJ) are limited. The aim of the present study was to investigate the involvement of osteoclasts at sites of bone erosion by determining the CTR expression and the RANKL:OPG expression ratio in the TMJ in a collagen-induced arthritis (CIA) model. Forty-eight male Wistar rats were randomly divided into two groups: Control group, injected with saline solution for 6 weeks; and CIA group, injected with emulsion. The RANKL and OPG mRNA expression was significantly increased in immunized rats compared with that in non-immunized rats. The RANKL:OPG expression ratio on the trabecular bone surface was 9.0 and 6.4 in the CIA group at weeks 4 and 6, respectively, while the RANKL:OPG expression ratio in the controls was 1.0:2. CTR mRNA expression was significantly upregulated in immunized rats compared with that in non-immunized rats; the level of CTR mRNA in the CTR-positive osteoclasts on the trabecular bone surface was 10.9- and 7.8-fold higher in the CIA rats than that in the control rats at weeks 4 and 6, respectively. In conclusion, focal bone destruction in an experimental model of arthritis in the TMJ can be attributed to cells expressing CTR, a defining feature of osteoclasts. The expression of RANKL and OPG mRNA within the inflamed synovium provides an insight into the mechanism of osteoclast differentiation and function at the border of bone erosion in arthritis.
25019624 Long-term outcome of 114 adult JIA patients in a non-pediatric rheumatology institute in J 2015 Jan OBJECTIVE: To evaluate the long-term outcome of patients with juvenile idiopathic arthritis (JIA) using data from a large cohort database, Institute of Rheumatology, Rheumatoid Arthritis, managed by the Tokyo Women's Medical University. METHODS: Of 182 patients identified from the database from 2000 to 2013, 114 were verified as having JIA. The transition of medical care and the contributions of biological DMARDs were evaluated. RESULTS: The mean age of the patients (93 females, 81.6%) at the latest examination was 36.6 ± 13.3 years. The mean age at disease onset and mean disease duration were 11.6 ± 3.4 and 25.0 ± 13.3 years, respectively. Of the 114 patients, 106 (93.0%) had poly- or oligoarthritis. Only one-fourth transferred from general pediatricians or pediatric rheumatologists. More patients with recent disease onset were treated with biological DMARDs (16.7% in the 1970s, vs. 80.0% in the 2000s). Disease activity assessed with DAS28 was significantly lower when disease onset was more recent (3.9 ± 1.3 for onset in the 1960s vs. 2.2 ± 1.1 for onset in the 2000s, p = 0.04). The percentage of patients requiring orthopedic surgery has decreased (53.8% before the 1970s vs. 10.0% in the 2000s). CONCLUSION: Patients with more recent disease onset showed an improved outcome. Establishing and sharing a transition program among pediatric and non-pediatric rheumatologists is desirable.
27312420 Pollutants make rheumatic diseases worse: Facts on polychlorinated biphenyls (PCBs) exposu 2016 Jul 15 BACKGROUND: Polychlorinated biphenyls (PCBs) are persistent organic pollutants that bioaccumulate in adipose tissue, disturbing its metabolism and the balance of adipokines, related to obesity. The altering secretion pattern of adipokines from the adipose tissue and the increasing mechanical load in weight-bearing joints presented in obesity condition, are risk factors for osteoarthritis development. The most prevalent rheumatic diseases, osteoarthritis and rheumatoid arthritis, are chronic conditions that target the whole joints, leading to increasing disability and health care cost. The goal of this focused review is to summarize the current knowledge on the role of PCBs in osteoarthritis and rheumatoid arthritis pathogenesis. SEARCH STRATEGY: A PubMed search was managed using keywords as "rheumatic diseases", "polychlorinated biphenyls", "obesity" and "endocrine disruption". MAIN RESULTS OF THE REVIEW: The incidence of rheumatoid arthritis has been reported to be increased especially in urban areas in industrialized countries, emphasizing the importance of environment in the pathogenesis of rheumatic diseases. Analysis of two cohorts exposed to PCBs food contamination showed high incidence of arthritis. In addition, PCBs in serum correlated positively with the prevalence of self-reported arthritis. Few studies support the hypothesis that osteoarthritis development could be related to PCBs induction of chondrocytes apoptosis. CONCLUSION: Evidences have emerged for a relationship between PCBs and development of several types of arthritis. Further research is encouraged to determine the correlation between PCBs exposure and the development of rheumatic diseases.
27531825 Immune recognition of citrullinated epitopes. 2016 Oct Conversion of arginine into citrulline is a post-translational modification that is observed in normal physiological processes. However, abnormal citrullination can provoke autoimmunity by generating altered self-epitopes that are specifically targeted by autoantibodies and T cells. In this review we discuss the recognition of citrullinated antigens in human autoimmune diseases and the role that this modification plays in increasing antigenic diversity and circumventing tolerance mechanisms. Early published work demonstrated that citrullinated proteins are specifically targeted by autoantibodies in rheumatoid arthritis and that citrullinated peptides are more readily presented to T cells by arthritis-susceptible HLA class II 'shared epitope' proteins. Emerging data support the relevance of citrullinated epitopes in other autoimmune diseases, including type 1 diabetes and multiple sclerosis, whose susceptible HLA haplotypes also preferentially present citrullinated peptides. In these settings, autoimmune patients have been shown to have elevated responses to citrullinated epitopes derived from tissue-specific antigens. Contrasting evidence implicates autophagy or perforin and complement-mediated membrane attack as inducers of ectopic citrullination. In either case, the peptidyl deiminases responsible for citrullination are activated in response to inflammation or insult, providing a mechanistic link between this post-translational modification and interactions with the environment and infection. As such, it is likely that immune recognition of citrullinated epitopes also plays a role in pathogen clearance. Indeed, our recent data suggest that responses to citrullinated peptides facilitate recognition of novel influenza strains. Therefore, increased understanding of responses to citrullinated epitopes may provide important insights about the initiation of autoimmunity and recognition of heterologous viruses.
26903291 Adjuvant-induced mono-arthritis potentiates cerebral hemorrhage in the spontaneously hyper 2016 Apr 15 AIMS: Patients with rheumatoid arthritis (RA), have a higher incidence of hypertension and stroke than the normal population. Currently there exists no animal model to study the pathogenic interactions of hemorrhagic stroke (HS) subsequent to chronic inflammation and hypertension. We have created and defined a hypertensive-mono-arthritic animal model who demonstrate gros signs of cerebral hemorrhage in presence of mono-arthritis. MAIN METHODS: Spontaneously hypertensive rats (SHR) were fed either a high salt diet (4% NaCl; HSD) or Purina chow (RD) from weaning. Complete Freund's adjuvant (CFA) was injected into the left hind paw at 21-28weeks (control groups received saline (SAL)). Degree of inflammation, joint swelling, weight and blood pressure were monitored for 21days. Animals were then sacrificed and their brain and left hind paw evaluated. KEY FINDINGS: All groups were hypertensive throughout the experimental period (>180mmHg systolic), irrespective of diet. Both CFA groups produced significant local inflammatory response in their injected paw with associated joint degradation and cellular infiltrates. Systemic plasma TNF-α levels were significantly elevated in CFA groups, with significant increase in TNF-α at 7 and 14days, compared to SAL groups. Cerebral hemorrhage was visualized in the CFA groups but not SAL controls, with a higher severity in HSD-CFA group. SIGNIFICANCE: The mono-arthritic hypertensive animals are capable of developing HS upon induction of inflammatory insult. The HSD appears to exacerbate the inflammatory response and influence degree of the hemorrhage. Our novel, multi-disease model may provide an appropriate platform to study the pathogenesis of HS among arthritic patients.
26500935 Anti-perinuclear Factor as Diagnostic Marker in Rheumatoid Arthritis. 2015 Sep INTRODUCTION: Rheumatoid Arthritis (RA) is a systemic autoimmune disease. It is associated with several auto antibodies which can serve as diagnostic and prognostic markers. AIM: In this study, Anti perinuclear Factor (APF) was evaluated as a biomarker in comparison with Rheumatoid Factor (RF) in Rheumatoid Arthritis. MATERIALS AND METHODS: Fifty two sera of patients with RA (mean age 48±15.8), 23 sera of Patient control group (mean age 32.5 ± 16.9) and 30 sera of Healthy control group (mean age 32.1± 16.9) were analysed. The method is based on the binding of APF to perinuclear keratohyalin granules of buccal mucosal cell and its detection using a fluorescently labeled anti human total antiserum. RESULTS: APF were found in 71.2 %(37/52) of patients with RA. The sensitivity and specificity for APF from 1/5 serum dilution was 71.2% and 94.3% respectively. RF test had higher sensitivity (88.5%) compare to the APF test (71.2%), but its specificity was (86.8%) less than APF (94.3%). There was no significant relationship between the onset of APF and severity of disease but there was significant relationship between the APF titer and severity of disease (p<0.05). CONCLUSION: It is concluded that APF test is a valuable serological tool for the diagnosis of the disease and a useful serological marker to differentiate from the other inflammatory rheumatoid diseases.
27352179 Artesunate interfere in modulation of Foxp3 expression in synovial cells in collagen-induc 2016 Jun 28 OBJECTIVE: To investigate the expression and significance of forkhead/winged helix (Foxp3) in rat synovial cells in collagen-induced arthritis rats after artesunate interventions. METHODS: A male Wistar rat model of type II collagen-induced arthritis (CIA) was established. The synovia was removed, and synovial cells were cultured for 5-7 generations. The cells were divided into a normal control group, a CIA model group, artesunate groups at different concentrations (5, 10, and 20 ng/mL), and a hydroxychloroquine group. The expressions of the Foxp3 gene in the groups were detected by reverse transcription polymerase chain reaction, and their protein expressions were detected by western blotting. RESULTS: In the drug intervention and CIA model groups, Foxp3 gene and protein expressions increased. The Foxp3 gene and protein expressions in the drug intervention groups were higher than those in the CIA model group, and fiber-like synovial cells numbers decreased. Foxp3 in the artesunate group was expressed at a greater level than the levels expressed in the control groups (P<0.05). Significantly increased of expression was observed in the 20 ng/mL artesunate group compared with the model group (P<0.05). CONCLUSIONS: Artesunate could increase the expression of Foxp3 in a dose-dependent manner, and thus reduce pannus formation and erosion of cartilage and bone to prevent lesions from rheumatoid arthritis.
29144636 2016 Mar 16 Key statement Research question The aim of the present investigation is to identify current, topic-relevant, evidence-based guidelines, extract their recommendations and designate those recommendations that are relevant for the care of patients in a disease management programme (DMP) “rheumatoid arthritis” (RA). Conclusion On the basis of Grades of Recommendation (GoR) or alternatively of Levels of Evidence (LoE) of extracted recommendations from current evidence-based guidelines, relevant and potentially relevant recommendations on all prespecified healthcare aspects were identified for a DMP “rheumatoid arthritis”, with the exception of the healthcare aspect of rehabilitation. The recommendations identified on diagnostics refer to the physical examination or the measurement of general and specific inflammatory parameters in the blood. A treat-to-target therapy is named for the planning of the individual treatment strategy. Remission and/or minimization of disease activity are named as treatment goals. Recommendations on the design of physiotherapy, on occupational therapy, diet as well as on the use of orthoses were identified in the section “Non-drug therapy and general measures”. Recommendations on the following subareas were identified for drug therapy: Recommendations across drugs for evaluation of the treatment goals “remission” and “reduction in disease activity”, as well as recommendations for regular monitoring of drug therapy. Recommendations on disease-modifying antirheumatic drugs (DMARDs): recommendations on the use of conventional synthetic and biological DMARDs (csDMARDs and bDMARDs) are described. The recommendations refer to the selection of suitable drugs and drug combinations depending on disease duration, symptoms, previous treatment attempts, clinical response, and tolerance. Further recommendations refer to the conduct and monitoring of DMARD therapy. Recommendations for patients with RA and specific disease constellations or comorbidities. Recommendations on symptomatic and anti-inflammatory treatment with glucocorticoids, non-steroid anti-inflammatory drugs (NSAIDs), cyclooxygenase-2 (COX-2) inhibitors, and analgesics as well as on treatment with dietary supplements. The recommendations identified on the monitoring of disease activity refer to the measurement instrument to be used and the time intervals. Furthermore, recommendations on the compilation of a multidisciplinary team and on nursing management of RA were identified for the healthcare aspect “cooperation of healthcare sectors”. The recommendations on patient training refer to the content and design of training.