Arthritis Glossary

If you are living with a type of arthritis, you’ll likely come across these terms – from copayments to comorbidity to double therapy. Here are some of the most common terms and what they mean.

This information is part of CreakyJoints’ comprehensive guide for patients living with rheumatoid arthritis. Learn more or download Raising the Voice of Patients: A Patient’s Guide to Living with Rheumatoid Arthritis.

Anti-cyclic citrullinated peptide proteins
An antibody present in 60 to 70% of patients with rheumatoid arthritis. About 90% of people with this antibody have or will develop rheumatoid arthritis over time. It is usually checked in the blood and can also be referred as anti-CCP.

Anxiety
A general uncomfortable feeling of nervousness and apprehension about something that is happening or about to happen.

Approved
The Food Drug Administration (FDA) has issued permission for a given medication to be commercialized for a specific disease entity.

Autoimmunity
State in which our own immune system becomes dysfunctional and starts attacking ourselves. Examples of autoimmune diseases include rheumatoid arthritis, lupus, scleroderma, and Hashimoto’s thyroiditis.

Biologic
Highly sophisticated and genetically engineered medications that target specific components that cause inflammation. These medications have been widely used in rheumatology and oncology.

Biosimilar
Genetically engineered medication designed to have structure and activity highly similar to the original biologic licensed.

Bone density
Measurement used to assess the strength of the bones. It is widely available and is the way the diagnosis of osteoporosis is made.

BUN
Stands for blood urea nitrogen. It is a marker of kidney function and can fluctuate a little depending on dehydration status.

C-reactive protein
Protein released by the liver; high values correlate with the inflammation status of the body. It is widely used in blood tests to assess overall inflammation. Although sensitive, it not specific for rheumatoid arthritis and many conditions can cause elevation.

Clinical trial
Lengthy and costly process that new medications have to go through in order to be approved by the FDA. Usually the new medication is compared to the current standard of care (best treatment available) or to placebo (no treatment).

Combination therapy
Treatement that involves being on more than one medication in order to control the disease. Some medications work better when used concomitantly (i.e. methotrexate + biologic).

Comorbidity
Refers to another concomitant disease one might have aside from the primary condition. For rheumatoid arthritis, many patients have as comorbidity obesity, diabetes, high blood pressure, depression, and heart disease

Complete blood count
This is a blood test that reflects our white cells (army against infection), red cells (cells that carry oxygen to tissues), and platelets (fragments of cells that prevent us from bleeding).

Contraindications
Statement used often to reflect that one should avoid a certain type of treatment or procedure because of possible harm (i.e. a pregnant patient should never take methotrexate because if would harm the baby).

Copayments
Portion of the cost of medication, procedure, or hospital stay that the patient is responsible for. Generally, insurance companies cover most of the cost but the patient may be responsible for some copayment.

Corticosteroid
Highly effective medication to treat inflammatory disorders and widely used. Given its multiple side effects, patients should not be on it for a long period of time.

Creatinine
A blood test that reflects the kidney function. Since many medications are cleared and can affect kidney function, it is a very commonly checked laboratory value.

Depression
A state in which patients have a persistent feeling of sadness, hopelessness, and difficulty finding pleasure in things that otherwise provided them pleasure. Depression is very common in chronic disease patients.

Disease activity
Objective measurement of inflammation attributable to the disease. Doctors have developed tools and scoring systems to assess how mild, moderate, or severe the disease state is at a given point.

Disease-specific markers
Blood tests that are associated with a given disease. In rheumatoid arthritis the most specific marker is the anti-CCP.

DMARD
Stands for disease modifying anti-rheumatic drug. These are medications that not only alleviate symptoms but slow or stop the progression of the disease (i.e. preventing erosions, nodules, lung problems).

Dosage
Expression used to quantify the amount of a given medication a patient is taking. That can be expressed in many units (i.e. methotrexate 2.5mg; prednisone 30mg).

Double therapy
Treatment in which a patient takes two medications for the same disease. It is very similar to combination therapy but limited to two medications.

Early RA
A term widely used to classify patients who have had symptoms of rheumatoid arthritis for less than six months. The definition, however, is controversial.

Erythrocyte sedimentation rate
Blood test used to assess inflammation. Very commonly used but it is not specific to rheumatoid arthritis and it can be elevated in a myriad of conditions including cancer and infections.

Established RA
Term used characterize patients with rheumatoid arthritis who have experienced symptoms of or have been diagnosed with rheumatoid arthritis for greater than six months.

Evidence
Evidence is the presence of information through research studies regarding a given intervention. The evidence can be positive or negative and many clinicians use the scientific evidence to base their treatment choices.

Fail First
Terminology used by providers to describe Step Therapy, as patients must first fail on less expensive medications before an insurance company will cover the cost of potentially more effective but costly options.

Generic drug
Medication that is equivalent to the branded (original) drug in dosage, quality, and route of administration. Usually generic drugs are less expensive.

Glucocorticoid
Highly effective medication to treat inflammatory disorders and widely used. Given its multiple side effects, patients should not be on it for a long period of time.

Inflammation
Process where our white cells (army against infections) and their products become hyperactive. Physically shown as redness, warmth, swelling, and pain.

Inflammatory markers
Blood tests that are surrogate markers of how inflamed the body is at a given point. These markers are routinely used in rheumatology

Interchangeable
Designation given to a biosimilar beyond its structural similarity to the original drug after it has proven clinical efficacy in a patient. The practical implication is that interchangeable biosimilar may be substituted for the reference product without intervention of a physician.

Janus kinase inhibitor
Medication that works by inhibiting a specific pathway of the immune system called janus kinase. Medications approved include tofacitinib.

Monitoring
Monitoring relates to the need of frequent objective assessments (blood tests or X-rays) to measure progression of disease and side effects from the medications.

Monotherapy
Term used when only one medication is being used to treat a given disease.

Non-disease-specific markers
Tests that can be present in rheumatoid arthritis but are also found in a variety of diseases. Examples include elevated C-reactive protein and sedimentation rate.

Non-TNF biologic
Class of medications that are genetically engineered but the mechanism of action is not inhibition of tumor necrosis factor (TNF). Examples include abatacept, tocilizumab, and rituximab.

On the market
Relates to medications that are currently commercialized and available for patients.

Prior Authorization
A process through which a provider must request authorization from the patient’s insurance company to prescribe a particular treatment. The process is often lengthy and complicated, and can delay important patient care.

Radiological progression
Objective rating used by doctors to assess changes in the joint structure using X-ray exams. Usually it reflects new erosions (tiny holes) in the bone and it is a sign that the medication is not fully working.

Recommendations
Statements made by a committee comprised by very knowledgeable experts in the field of rheumatoid arthritis. They help clinicians follow a basic algorithm but in the end, treatment should be individualized.

Reference drug
Relates to the original pioneer drug. For the biosimilar example, the reference drug is the original biologic (i.e. infliximab for inflectra).

Remission
State in which signs and symptoms are controlled, and based on objective examination by the doctor, the disease activity is low. This is the ultimate goal in treating rheumatoid arthritis.

Rheumatoid arthritis
Autoimmune disorder characterized by progressive joint inflammation that can lead to joint damage and destruction.

Rheumatoid factor
Antibody present in patients with rheumatoid arthritis but also seen in a variety of other conditions. It is tested through a blood sample.

Rheumatoid nodules
Small firm lumps that develop under the skin in patients with rheumatoid arthritis. They are generally near the inflamed joint.

Rheumatologist
Physician who specializes in systemic autoimmune illnesses and arthritis. Training comprises three years of internal medicine and later a two- to three-year fellowship in rheumatology.

Self-administration
Term used to characterize a medication that, although not necessarily as simple as a pill, can be administered by the patient without a healthcare provider being involved. Example is the subcutaneous injections for TNF inhibitors.

Side effects
Unwanted or undesirable effects of certain medications or procedures. All medications have side effects and that should be monitored carefully.

Specialty pharmacy
Specific segment of a pharmacy chain that deals with high-cost and complex medications.

Step Therapy
The process in which an insurer requires providers to follow “tiers” based on cost when prescribing medications. In most cases, the least expensive medication must be prescribed first, and progression to other options is only allowed after a patient has been shown to “fail” on the initial medication.

Substitution
Ability of the pharmacist to change from an interchangeable biosimilar to its reference drug. There is currently no available interchangeable biologic but this is expected in the near future.

Synovium
Membrane that surrounds the joint and produces synovial fluid, which “lubricates the joint” for smoother movement.

TNFi biologic
Genetically engineered medication designed to inhibit tumor necrosis factor, which plays a major role in the inflammation seen in rheumatoid arthritis. These medications are approved for rheumatoid arthritis and have revolutionized the field of rheumatology.

Transaminase
Liver enzymes that are measurable through a blood test. The liver metabolizes most medications; therefore, it is important to monitor such enzymes to assess if the drugs are causing any damage to the liver.

Treatment Guidelines
Published periodically, treatment guidelines are designed to help standardize care for a given disease. It is normally a consensus of multiple experts in the field who thoroughly evaluate the scientific evidence and develop clinical guidelines.

Treatment plan
The result of a conversation between the patient and doctor. It outlines a strategy on how to cope with the disease. That includes medications, physical therapy, and alternative therapies.

Triple therapy
Term used describe treatment of rheumatoid arthritis with three specific medications. Generally medications are methotrexate, hydroxychloroquine, and sulfasalazine.

Tumor necrosis factor
Major molecule that drives the inflammation in rheumatoid arthritis. Given the advances in pharmacology, there are now many drugs that inhibit its action, providing relief to patients.