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Rheumatoid Arthritis

  • Nages Nagaratnam
  • Kujan Nagaratnam
  • Gary Cheuk
Reference work entry

Abstract

The review provides an overview of the prevalence and mechanisms, with the main focus on age at onset. One-third of the patients with rheumatoid arthritis have their first symptom after the age of 60 years. In the elderly, RA takes two forms: (i) continuing into old age with younger-onset RA (YORA) and (ii) elderly-onset RA (EORA). Clinical emphasis is placed on these differences, for failure to recognise them may result in delay in diagnosis and treatment.

Keywords

Rheumatoid arthritis Elderly-onset rheumatoid arthritis (EORA) Young-onset rheumatoid arthritis (YORA) Anti-CCP (anti-cyclic citrullinated peptide antibody) Biological DMARDs (bDMARDs) 

References

  1. 1.
    Arthritis Foundation of South Africa. A brief history of RA and its treatment. http://healthunlocked.com/arthritisfoundatio/posts/427232/q-brief-history-of-ra-and-its-treatment. Accessed 2 February 2016.
  2. 2.
    Arcini C. Rheumatoid Arthritis-Rare reality as recovered among scanian skeletal remains from Viking and Medieval Times. Sydsvenska Medicinhistoriska. 1992;18:11–21.Google Scholar
  3. 3.
    Short CL. The antiquity of rheumatoid arthritis. Arthritis and Rheumatism. 1974;17(3):193–205.CrossRefPubMedGoogle Scholar
  4. 4.
    Basisht G, Singh RH, Chandola H. Management of rheumatoid arthritis (Aamavata) using symbiohealth health care system. Ayu. 2012; 33(4):466–474.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Entezami P, Fox DA, Clapmsan PJ, Chung KC. Historical perspective on the etiology of rheumatoid arthritis. Han Clin. 2011;27(1):1–10.CrossRefGoogle Scholar
  6. 6.
    Panush. Why did rheumatoid arthritis begin in 1800? http://www.the-rheumatologist.org/article/why-did-rheumatoid–arthritis-begi-in-1800/?singlepage=1. Accessed 1 February 2016.
  7. 7.
    Mandal A. Arthritis history. http://www.news-medical.net/health/Arthritis-History.aspx accessed 1 February 2016.
  8. 8.
    Appleboom T. ed Art, History and Antiquity of rheumatic Disease. Elsevier, Brussels, Erasmus FoundatioN. 1987.Google Scholar
  9. 9.
    Riley JC. Estimates of regional and global life expectancy. Population and development review. 2005;31(3):537–543.CrossRefGoogle Scholar
  10. 10.
    Majitha V, Geraci SA. Rheumatoid Arthritis: Diagnosis and Management. Am J Med. 2007;120:936–939.CrossRefGoogle Scholar
  11. 11.
    Kahkenberg JM, Fox DA. Advances in the medical treatment of rheumatoid arthritis. Han Clin. 2011;27(11):11–20.CrossRefGoogle Scholar
  12. 12.
    Gibofsky A. Overview of epidemiology pathophysiology and diagnosis of rheumatoid arthritis. Am J Manag Care. 2012;18(3suppl)S295=30.Google Scholar
  13. 13.
    Ruffing V, Bingham CO. Rheumatoid arthritis, signs and symptoms. www.hopkinsarhitis.org/arhritis-info/rheumatod:arthtitis/ra-symptoms/
  14. 14.
    Choy E. Understanding the dynamics: pathways involved in the pathogenesis of rheumatoid arthritis. Rheumatology. 2012;51(suppl 5):v3-v11.  https://doi.org/10.1093/rheumatology/kes113.CrossRefPubMedGoogle Scholar
  15. 15.
    Abdel-Nasser AM, Rasker JJ, Valkenburg HA. Epidemiological and clinical aspects relating to the variability of rheumatoid arthritis. Semi Arthritis Rheum. 1997;27(2):123–40.CrossRefGoogle Scholar
  16. 16.
    Alamanos Y, Voulgari PV, Drosos AA. Incidence and prevalence of rheumatoid arthritis based on the 1987 American College of Rheumatology criteria: a systematic review. Semi Arthritis Theum 2006;36(3):182–8.CrossRefGoogle Scholar
  17. 17.
    Kvien TK. Epidemiology and burden of illness of rheumatoid arthritis. Pharmaco Economics. 2004;32:1–12.CrossRefGoogle Scholar
  18. 18.
    Negoescu A, Ostor AJ. Early recognition improves prognosis in elderly onset RA. Practitioner. 2014; 258(1767):11–4,2.PubMedGoogle Scholar
  19. 19.
    Diaz-Borjon A. Guidelines for the use of conventional and newer disease-modifying antirheumatic drugs in elderly patients with rheumatoid arthritis. Drugs Aging. 2009;26(4):273–93.CrossRefPubMedGoogle Scholar
  20. 20.
    Turkcapar N, Demir O, Atli T, Kopuk M, Turgay H, Kinikli G, et al. Late onset rheumatoid arthritis: clinical and laboratory comparisons with younger onset patients. Arch Gerontol Geriatr. 2009;42:225–231.CrossRefGoogle Scholar
  21. 21.
    Woodworth T, Ranganath V, Furst DE. Rheumatoid arthritis in the elderly: recent advances in understanding the pathogenesis, risk factors, comorbidities and risk-benefit of treatments. Aging Health 9(2):167–178.  https://doi.org/10.2217/ahe.13.15.
  22. 22.
    Hopkins A, Lozado CJ. Elderly onset rheumatoid arthritis. A distinct clinical entity? Clin Geriatrics. 2008;16:40–46.Google Scholar
  23. 23.
    Laiho K, Teiomilehto J, Tavis R. Prevalence of rheumatoid arthritis and musculoskeletal disease in the elderly population. Rheumatol Int. 2001;20(3):85–7.CrossRefPubMedGoogle Scholar
  24. 24.
    Rasch EK, Harsch R, Paulose-Ram R, Hochberg MC. Prevalence of rheumatoid arthritis in persons 60 years of age and older in the United States: Effect of different methods of case classification. Arthritis Rheum. 2003; 48(6):917–926.Google Scholar
  25. 25.
    Symmons D, Turner G, Webb R, Asten P, Burett E, Lunt M, et al. The prevalence of rheumatoid arthritis in the United Kingdom: new estimates for a new century. Rheumatology. 2002;41(7):793–800.CrossRefPubMedGoogle Scholar
  26. 26.
    Olivieri N, Pipitone N, D’Angelo S, Padula A, Salvarani C. Late-onset rheumatoid arthritis and late-onset spondyloarthritis. Clin Exp Rheumatol 2009; 27(Suppl55):S139-S145.PubMedGoogle Scholar
  27. 27.
    Filipowicz-Sosnowski A, Rupinski. Elderly onset rheumatoid arthritis. Pol Arch Med Wewn. 2008;118 Suppl:36–42.Google Scholar
  28. 28.
    Amador-Patarroyo MJ, Rodriguez A R, Oritz GM. How does age at onset influence the outcome of autoimmune diseases? Autoimmune Diseases 2012(2012, Article ID251730, 7 pages.  https://doi.org/10.1155/2012/251730.
  29. 29.
    Evcik D. An overview of late-onset rheumatoid arthritis. Editorial. Turk J Rheumatol. 2013;28(2):67–68.CrossRefGoogle Scholar
  30. 30.
    Deal CL, Meenan RF, Goldenberg DL, Anderson JJ, Sack B, Pastan RS, et al. The clinical features if elderly onset rheumatoid arthritis: A comparison with younger onset disease of similar duration. Arthritis Rheum. 1985;28(9):987–94.CrossRefPubMedGoogle Scholar
  31. 31.
    Bajoochi G, La Corte R, Locaputo A, Govoni M,Trotta F. Elderly onset rheumatoid arthritis: clinical aspects. Clin Exp Rheumatol. 2000;18(4 Suppl 20): S49–50.Google Scholar
  32. 32.
    Kurko J, Besenyei T, Laki J, Glant TT, Mihecz K, Szekanecz Z. Genetics of rheumatoid arthritis-a comprehensive review. Clin Rev Allergy Immunol. 2013;45(2):170–9.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Kawabata K, Yamamoto K. Recent advances in the pathogenesis of rheumatoid arthritis. Clin Calcium. 2009;19(3):303–9. doi:CliCa0903303309.Google Scholar
  34. 34.
    Lee W-Y, Chen H-Y, Chen K-C, Chen Y-C. Treatment of rheumatoid arthritis with traditional Chinese medicine. BioMed Res Int.  https://doi.org/10.1155/2014/528018. Accessed 30 january 2016.
  35. 35.
    Plenge RM, Seielstad M, Padyukov L, Lee AT, Remmers EF, Ding B, et al. ‘TRAFI-C5 as a risk locus for rheumatoid arthritis-a genomewide study. NEJM. 2007;357(12):1199–1209.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Silman AJ, Macgregor AJ, Thomson W, Holigan S, Carthy D, Farhan A, et al. Twin concordance rates for rheumatoid arthritis: results of a nationwide study. Brit J Rheumatol. 1993;32(10):903–907.CrossRefGoogle Scholar
  37. 37.
    Bellamy N, Duffy D, Martin N, Mathews J. Rheumatoid arthritis in twins: a study of aetiopathogenesis based on the Australian Twin Registry. Ann Rheumat Dis. 2010;69(1):70–81.CrossRefGoogle Scholar
  38. 38.
    Agarwal SK. Biologic agents in rheumatoid arthritis: an update for managed care professionals. J Manag Care Pharm. 2011;17(SupplIB) S14–8.PubMedGoogle Scholar
  39. 39.
    Smolen JS, Steiner G. Therapeutic strategies for rheumatoid arthritis. Nat Rev Drug Discov. 2003;2:47–88.CrossRefGoogle Scholar
  40. 40.
    Smolon JS, Aletana D, Koeller M, Wiseman MH, Emery P. New therapies for the treatment of rheumatoid arthritis. Lancet. 2007;370;1861–74.CrossRefGoogle Scholar
  41. 41.
    Fantini F. New Drugs and treatment strategies for rheumatoid arthritis. Recent Prog Med. 2003;94(9):361–79.Google Scholar
  42. 42.
    McInnes IB, Schett G. Cytokines in the pathogenesis of rheumatoid arthritis. Nat Rev Immunol. 2007;7:429–4.CrossRefPubMedGoogle Scholar
  43. 43.
    Firestein GS. Evolving concepts of rheumatoid arthritis. Nature. 2003;423:356–61.CrossRefPubMedGoogle Scholar
  44. 44.
    Chikanza IC, Kingsley G, Panayi S. Peripheral blood and synovial fluid monocyte expression of interleukin-1 alpha and -1 beta during active rheumatoid arthritis. J Rheumatol. 1995;22:600–608.PubMedGoogle Scholar
  45. 45.
    Fong KY, Boey ML, Koh WH, Feng PG. Cytokine concentrations in the synovial fluid and plasma of rheumatoid arthritis patients correlation with bony erosions. Clin Exp Rheumatol. 1994;12:55–58.PubMedGoogle Scholar
  46. 46.
    Arend WP, Dayer JM. Cytokines and cytokine inhibitors or antagonists in rheumatoid arthritis. Arthritis Rheum. 1990;33:305–315.CrossRefPubMedGoogle Scholar
  47. 47.
    van den Beg. Joint inflammation and cartilage destruction may occur unrecognized. Springer Semin Immunopathol. 1998;20:149–164.CrossRefGoogle Scholar
  48. 48.
    van den Lent PL, van De Loo FA, Holthuysen AE, van Den Berssalar LA, Vemeer H, van Den Bergh B. Major role for IL-1 but not for TNF in early cartilage damage in immune complex in mice. J Rheumatol. 1995;22:2250–2258.PubMedGoogle Scholar
  49. 49.
    Chen DY, Hsieh TY, Chen YM, Hseih CW, Lan JL, Lin FJ. Proinflammatory cytokine profiles of patients with elderly onset rheumatoid arthritis: a comparison with younger onset disease. Gerontology. 2001;55(3):250–8.CrossRefGoogle Scholar
  50. 50.
    Choi Y, Arron JR, Townsend MJ. Promising bone-related therapeutic targets for rheumatoid arthritis. Nature Rev Rheumatol. 009;5:543–548.Google Scholar
  51. 51.
    Balandraud N, Roudier J, Roudier C,. Epstein-Barr virus and rheumatoid arthritis. Autoimun Rev. 2004;3:362–367.CrossRefGoogle Scholar
  52. 52.
    Costenbader KH, Karison EW. Epstein-Barr virus and rheumatoid arthritis: Is there a link? Arthritis Res Ther. 008;8(1):204.  https://doi.org/10.1186/art893.
  53. 53.
    Alvarez-Lafuente R, Fernandez-Gutierrez B, Miguel S, Jover JA, Rollin R, Loza E, et al. Analysis with a quantitative real time polymerase chain reaction. Am Rheum Dis. 2005;64:1357–1359.CrossRefGoogle Scholar
  54. 54.
    Mercado FB, Marshall RI, Kestor AC, Bartold PM. Relationship between rheumatoid arthritis and periodontitis. J Periodontol. 2001;72(6):779–87.CrossRefPubMedGoogle Scholar
  55. 55.
    Kasser UR, Gleissner C, Dehne F, Michel A, Willershausen-Zonnchen B, Bolton WW. Risk of periodontal disease in patients with long standing rheumatoid arthritis. Arthritis Reum. 1997;40 (12):2248–51.CrossRefGoogle Scholar
  56. 56.
    Loyala-Rodrigues JP, Martinez-Martinez RE, Abud-Mendoza C, Patcho-Manin N, Seymour GJ. Rheumatoid arthritis and role of oral bacteria. J Oral Microbiol. 2010:2:  https://doi.org/10.3402/jom.v210.5784.
  57. 57.
    van Schaardenberg D. Rheumatoid arthritis in the elderly. Prevalence and optimal management. Drugs Aging. 1995;7:30–7.CrossRefGoogle Scholar
  58. 58.
    Grassi W, De Angelis R, Lamanna G, Cervini C. The clinical features of rheumatoid arthritis. Eur J Radiol. 1998; 27 Suppl 1:S18–24.CrossRefPubMedGoogle Scholar
  59. 59.
    Rindfleisch JA, Muller D. Diagnosis and management of rheumatoid arthritis. Am Fam Physician. 2005;72:1036–1047.Google Scholar
  60. 60.
    Bingham CO. Rheumatoid Pathophysiology. The John Hopkins Arthritis Center. http://www.hopkinsarthrtis.org/arthritis-info/rheumatoid–arthritis/ra-pathophysiology-2/ retrieved 27 August 2013.
  61. 61.
    Ceccato F, Roverano S, Barrionucia A, Rillo O, Paira S. The role of anticyclic citrullinated peptide antibodies in the differential diagnosis of elderly onset rheumatoid arthritis and polymyalgia rheumatic. Clin Rheumatol. 2006; 25(6):854–7.CrossRefPubMedGoogle Scholar
  62. 62.
    Lopez-Hoyos H, De Algeria R, Crespo BR, Pena M, Rodriguez-Valverde V, Mastinez-Taboada VM. Clinical utility of anti-CCP antibodies in the differential diagnosis of elderly onset rheumatoid arthritis and polymyalgia rheumatica. Rheumatology (Oxford). 2004; 43(5):655–7.CrossRefGoogle Scholar
  63. 63.
    Suresh E. Recent advances in rheumatoid arthritis. Postgrad Med J. 2010;86(1014):243–50.CrossRefPubMedGoogle Scholar
  64. 64.
    Reouw LA, Mahler M. Closing the serological gap: promising novel biomarkers for the early diagnosis of rheumatoid arthritis. Autoimmune Rev. 2012; 12(2):18–32.Google Scholar
  65. 65.
    McInnes IB, Schett G. The pathogenesis of rheumatoid arthritis. NEJM. 2011;365:69 2205–2219.CrossRefPubMedGoogle Scholar
  66. 66.
    American College of Rheumatology Subcommittee on Rheumatoid Arthritis Guidelines. Guidelines for the management of rheumatoid arthritis: 2002 update.Google Scholar
  67. 67.
    Olivieri I, Palazzi C, Peruz G, Padula A. Management issues with elderly onset rheumatoid arthritis. an update. Drugs Aging. 2005;22(10): Seg -22.CrossRefGoogle Scholar
  68. 68.
    Zuckerman E, Keren D, Rozenbaum M, Toubi E, Slobodin G, Tamir A, et al. Hepatitis C virus-related arthritis: characteristics and response to therapy with interferon alpha. Clin Exp Reumatol. 2000;18:579–584.Google Scholar
  69. 69.
    Stenstrom CH, Minor MA. Evidence for the benefits of aerobic and strengthening exercise in rheumatoid artheritis. Arthritis Rheum. 2003;49:428–434.CrossRefPubMedGoogle Scholar
  70. 70.
    Shaw K,Zochling J, Winzenberg T. Non-pharmacological interventions in rheumatoid arthritis. Aust Fam Physician. 2007;36:840–841.PubMedGoogle Scholar
  71. 71.
    Tayar JH, Suarez-Almazor M. New understanding and approaches to treatment of rheumatoid arthritis. Br Med Bull. 2010; 94(1):201–214.CrossRefPubMedGoogle Scholar
  72. 72.
    Kim GW, Lee NR, Pi RH, Lim YS, Lee YM, Lee JM, et al. IL-6 inhibitors for treatment of rheumatoid arthritis: past, present and future. Arch Pharm Res. 2015;38(5):575–584.CrossRefPubMedGoogle Scholar
  73. 73.
    Waters L, Moots R. Recent advances in treatment and diagnosis of rheumatoid arthritis. prescriber.co.uk. 19 February 2014.Google Scholar
  74. 74.
    Buch MH, Emery P. New therapies in management of rheumatoid arthritis. Curr Opin Rheumatol. 2011; 23(3):250–251.CrossRefGoogle Scholar
  75. 75.
    Genovere MC, Kreme J, Zamarri O, Ludivico C, Krogulec M, Li Xie MS, et al. Baricitinib in patients with refractory rheumatoid arthritis. NEJM. 2016; 374:1243–1252.CrossRefGoogle Scholar
  76. 76.
    Therapeutic Guidelines. Rheumatology ,Version. 2006.Google Scholar
  77. 77.
    Calabrese LH. Rheumatoid arthritis and primary care: the case for early diagnosis and treatment. J Am Osteopath Assoc. 1999; 99(6): 313–21.CrossRefPubMedGoogle Scholar
  78. 78.
    Fries JF. Current treatment paradigms in rheumatoid arthritis. Rheumatology (Oxford). 2000;39 Suppl 1:30–5.CrossRefGoogle Scholar
  79. 79.
    Gaffo A, Saag KG, Curtis JR. Treatment of rheumatoid arthritis. Am J Health Syst Pham. 2006; 63(24):2451–65 .CrossRefGoogle Scholar
  80. 80.
    Chen VF, Jobanputra P, Barton P, Jowell S, Bryan S, Claark W, et al. A systematic review of the effectiveness of adalimumab, etanercept and infliximab for the treatment of rheumatoid arthritis in adults and an economic evaluation of their cost-effectiveness. Health Technol Assess. 2006;10:iii–iv,1–229.Google Scholar
  81. 81.
    Yazici Y, Paget SA. Elderly on set rheumatoid arthritis. Dis Clin North. Am 2000;26:517–26.CrossRefGoogle Scholar
  82. 82.
    Gabriel SE, Jaakkimaimen I, Bombardier C. Risk of serious systemic complications related to use of non-steroidal inflammatory drugs. A metaanalysis. Ann Int Med. 1991;115:787–96.CrossRefPubMedGoogle Scholar
  83. 83.
    Clifford LJ. Use of NSAIDs in treating patients with arthritis. Arthritis Res Therapy. 2013;15(3):52.  https://doi.org/10.1186/ar4o74.Google Scholar
  84. 84.
    Emery P, Breedveld FC, Dougados M, Kalden JR, Schiff MH, Smolen JS, et al. Early referral recommendations for newly diagnosed rheumatoid arthritis: evidence based development of a clinical guide. Am Rheum Dis. 2002;61:290–7.CrossRefGoogle Scholar
  85. 85.
    Boers M. Rheumatoid arthritis. Treatment of early disease. Rheum Dis Clin North Am. 2001;27:405–14CrossRefPubMedGoogle Scholar
  86. 86.
    Fleischmann R, Iqbal T, Nandeshwar P, Quiceo A, Safety and efficacy of disease –modifying anti-rheumatic agents: focus on the benefits and risks of etanercept. Drug Saf. 2002;25(3):173–97.CrossRefPubMedGoogle Scholar
  87. 87.
    Beach data. Australian General Practice Statistics and Classification Centre: a collaborator unit of the Family Medicine Research Centre, University of Sydney and the Australian Institute of Health and Welfare, August 2006.Google Scholar
  88. 88.
    Ruderman EM. Overview of safety of non-biologic and biologic DMARDs. Rheumatology 2012SP(Suppl6)vi37-v143.  https://doi.org/10.1093/rheumatology/kes283.
  89. 89.
    NPS News (National Prescribing Service Letter). Helping patients achieve remission of rheumatoid arthritis.48,2006.Google Scholar
  90. 90.
    Olsen NJ, Stein CM. New drugs for rheumatoid arthritis. N Engl J Med. 2004;350:2167–79.CrossRefPubMedGoogle Scholar
  91. 91.
    Cohen S, Cannon GW, Schiff M, Weaver A, Fox R, Olsen N, et al. Two-year, blinded, randomized controlled trial of treatment of active rheumatoid arthritis with leflunomide compared with methotrexate. Arthritis Rheum. 2001;44:1984–92.CrossRefPubMedGoogle Scholar
  92. 92.
    O’Dell JR, Haire CE, Erikson N, Drymalski W, Palmer W, Eckhoff PJ, et al. Treatment of rheumatoid arthritis with methotrexate alone, sulfasalazine and hydroxychloroquine or combination of all three medications. N Engl JMed. 1996;334:1287–91.CrossRefGoogle Scholar
  93. 93.
    O’Shea JJ, Kontzias A,Yamaoka K, Kubo S, Nakano K, Iwata S, et al. Janus kinase inhibitors in autoimmune diseases. Ann Rheum Dis. 2013;72 Suppl 2:ii111–5.CrossRefPubMedPubMedCentralGoogle Scholar
  94. 94.
    Walker J, Smith M. Janus kinase inhibitors in rheumatoid arthritis. Aust Prescriber. 2014;37:158–160.CrossRefGoogle Scholar
  95. 95.
    Hughes SL, Dunlop D. The prevalence and impact of arthritis in older persons. Arthritis Rheum. 8:257–264.  https://doi.org/10.1002/art.1790080409.
  96. 96.
    Helmick CG, Felson DT, Lawrence RC, Gabriel S, Hirsch R, Kwoh AK, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Arthritis Rheum. 2008;58(1):15–25.CrossRefPubMedGoogle Scholar
  97. 97.
    Pollard L, Choy EH, Scott DL. The consequences of rheumatoid arthritis: quality of life measures in the individual patient. Clin Exp Rheumatol. 2005;23(5Suppl 39):S43–52.PubMedGoogle Scholar
  98. 98.
    Sierakowska M, Krajewska-Kulak E, Sierakowski S. Quality of life in rheumatoid arthritis. Methods of measurement. Przegi Lek. 2005;62(3):188–91.Google Scholar
  99. 99.
    Lapsley HM, March LM, Tribe KL, Cross MJ, Courtenay BG, Brooks PM, for the Arthritis Cost and Outcome Project Group. Living with rheumatoid arthritis: expenditures, health status and social impact on patients. Ann Rheum Dis. 2002;61:818–821.CrossRefPubMedPubMedCentralGoogle Scholar
  100. 100.
    Scott DL, Smith C, Kingsley G. What are the consequences of early rheumatoid arthritis for the individual? Best Pract Res Clin Rheumatol. 2005;19(1):117–36.CrossRefPubMedGoogle Scholar
  101. 101.
    Strand V, Singh JA. Newer biological agents in rheumatoid arthritis: impact on health-related quality of life and productivity. Drugs. 2010;70(2):121–45.CrossRefPubMedGoogle Scholar
  102. 102.
    Dominick K, Ahern FM, Gold CH, Heller DA. Health-related quality of life among older adults with arthritis. Health Qual Life Outcomes. 2004;2:5.CrossRefPubMedPubMedCentralGoogle Scholar
  103. 103.
    Shanahan EM, Smith M, Roberts-Thomson L,Esterman A, Ahern M.. Influence of rheumatoid arthritis on work participation in Australia. Int Med J. 2008;38:166–173.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Nages Nagaratnam
    • 1
  • Kujan Nagaratnam
    • 1
  • Gary Cheuk
    • 2
  1. 1.The University of SydneyWestmead Clinical SchoolWestmeadAustralia
  2. 2.Rehabilitation and Aged Care ServiceBlacktown-Mt Druitt HospitalMount DruittAustralia

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