Treating early rheumatoid arthritis in the younger patient

Early diagnosis and intervention may provide the greatest hope for reducing the disability associated with rheumatoid arthritis (RA). in patients with early TW, accurate diagnosis can be delayed by Limited access to a special ist service, slow evolution of the clinical features, and lack of definitiv e diagnostic criteria. However, acute phase reactants, serologic features i ncluding presence of rheumatoid factor, and immunohistologic analysis of sy novial tissue can provide the basis for differentiating RA from other forms of arthritis. Factors associated with poorer prognosis in patients with ea rly RA are female sex, larger number of joints involved, elevated levels of acute phase reactants, presence of rheumatoid factor, and radiologic evide nce of joint damage. Special treatment considerations in younger persons wi th RA include issues related to conception, pregnancy, and lactation. Metho trexate, hydroxychloroquine, sulfasalazine, and low dose corticosteroids ar e usually the mainstays of treatment for younger patients with RA. Recommen dations for taking these drugs while considering conception vary with their effect on fertility and on the developing embryo. Sulfasalazine, for examp le, can be taken during pregnancy but caution is advised for breastfeeding mothers. Leflunomide must be discontinued for 2 years before attempting con ception; this time can be shortened if the patient opts for drug washout.