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From The Merck Manual of Diagnosis and Therapy, Edition 17, p. 22, edited by Mark H. Beers and Robert Berkow. Copyright 1999 by Merck & Co., Inc., Whitehouse Station, NJ.

From The Merck Manual of Diagnosis and Therapy, Edition 17, p. 22, edited by Mark H. Beers and Robert Berkow. Copyright 1999 by Merck & Co., Inc., Whitehouse Station, NJ.

whole-body protein breakdown and resting metabolic rate. Treatment begins with rest, physical therapy, and use of NSAIDs to reduce pain. Low-dose oral corticosteroids, equivalent to 5-10mgday_1 of prednisone, are often necessary to control symptoms. However, these therapies do not alter the natural history of the disease. The best chance of doing so rests with the so-called 'slow-acting anti-rheumatic drugs' (SAARDs), such as methotrexate, TNF-a inhibitors, and other medications that have been shown to prevent erosions. It should be noted that some of these medications may also affect the nutritional status of individuals with RA via either altered appetite, blood sugar, plasma lipids, absorption, or protein metabolism (Table 1).

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