Perspectives on Rheumatoid Arthritis for the Orthopedic Surgeon: Overview of Early Diagnosis and the Tumor Necrosis Factor Antagonists

Rheumatoid arthritis (RA) is the most common inflammatory arthritis in the United States. As part of ongoing efforts to halt joint damage, preserve func­tion, and reduce associated mortality, the current empha­sis in RA management is on prompt diagnosis and the early use of disease modifying anti­rheumatic drug (DMARD) therapy. Improved serologic tests and updated classification criteria are now avail­able to assist in making an earlier diagnosis of RA. As a therapeutic class, tumor necrosis factor antagonists are widely used by rheumatologists and provide significant benefits to patients who have an incomplete response to methotrexate or other DMARDs. With the reported low concordance between orthopedic surgeons and rheumatologists regarding the potential benefits of sur­gery to treat RA, there is an opportunity for improved collaboration between these specialties in the care of RA patients. Updates on diagnosis and medical therapy of RA may help orthopedic surgeons appreciate the rheumatologist’s approach to this disease.