Rheumatology and

Musculo-skeletal Clinic


Rheumatoid Arthritis

Rheumatoid Arthritis (RA) is the most common of the inflammatory arthritic conditions affecting 1-2% of women.  Prior to menopause it affects more women than men on a 6:1 ratio.  After menopause the ratio becomes close to 1:1 for new cases. 

Untreated RA leads to marked disability, deformities, poor quality of life, and a shortened life expectancy.  There are two antibodies associated with RA.  These are rheumatoid factor (RF) and anti-citrullinated protein (CCP).  RF is present in 10% of the population but only 1% get RA.  About 90% of RA patients are RF positive.  Anti-CCP antibodies are much more specific to RA and are also the main antibodies associated with forming erosions - the deforming bone damage in RA.

Treatment for RA includes a healthy diet, exercise, nutrition and medications.

Medications include Prednisone, Methotrexate, Sulphasalazine, Hydroxychloroquine, and Leflunomide.  Older medications such as Gold and Cyclosporin have a marked risk for kidney damage and are much less likely to be used. 

Biological medications such as Adalimumab, Infliximab, Etanercept, Rituximab, and Tocilizumab are expensive and have a high infection risk.  They are as effective as the standard medications, although they may lead to slightly less bone damage in CCP positive patients.